Rs 6.97 crore was paid to dead patients under PMJAY: CAG

Pointing out glaring irregularities in PM Modi’s ambitious Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (PMJAY) health insurance scheme, the Comptroller and Auditor General of India (CAG) said that around Rs 6.97 crore was allotted to the treatment of patients already declared dead previously in the database, The Indian Express reported.

PMJAY was launched in 2018 and is a scheme for both rural and urban areas with an aim to make healthcare accessible for economically downtrodden sections of the country. 

The scheme provides cover of Rs 5 lakh per family every year for secondary and tertiary care hospitalisation in both government as well as private hospitals. 

The performance audit, by the CAG said that around 3,446 patients earlier shown as ‘died’ in the (Transaction Management System of the scheme) got treatment under the scheme.

There were 3, 903 claims for 3,446 patients and that amounted to 6.97 crore was paid to hospitals across the country.

Among the states, Kerala had the most number of such ‘dead’ patients. In Kerala 966 such patients were paid Rs 2,60,09,723  for the ‘treatment’. Madhya Pradesh has 403 such patients for whom Rs 1,12,69,664 was paid. Chhattisgarh came in third with 365 patients and around Rs 33,70, 985 was paid for their treatment.

The existing guidelines mandates an audit of the patient if  they die after admission to a hospital and before discharge and the payment is done after the audit. 

The report further said that several mandatory checks were not followed, to which the National Health Authority (NHA) explained that due to certain reasons “back-date admission is allowed in the system”.
The report has asked NHA and SHA to investigate these cases to avoid irregular payments and fraudulence.

The CAG also pointed out that in 2,231 hospitals, there were 78,396 cases where the same patient were hospitalized to multiple medical institutions at the same time.