A new health insurance scheme will replace ‘Himcare’, one of the flagship schemes introduced during the previous BJP government, in Himachal Pradesh in November. The new scheme will make use of artificial intelligence (AI) to scrutinise medical bills and claims to weed out any kind of malpractices.
Under the new scheme, which the government says will “ensure transparency” and “help curb the possibility of corruption”, the eligible families in the state will receive free medical treatment coverage of up to ₹10 lakh.
A key feature of the new scheme is the use of artificial intelligence (AI) technology to scrutinise medical bills and claims. A technical analysis will be conducted on bills submitted by hospitals and records related to patient treatment.
To curb financial irregularities and prevent the misuse of public funds, the state government would be using AI to identify suspicious patterns, duplicate or unusual bills, fraudulent bills, and claims that do not align with the actual treatment provided. Such claims will then undergo further investigation. Provisions are also being made to take action against hospitals or individuals attempting to claim insurance payouts using fraudulent bills. Penalties and other punitive measures will be imposed if guilt is proven.
Chief minister Sukhvinder Singh Sukhu flagging “irregularities” in the HIMACRE scheme had announced its replacement with an insurance-based model in March this year in the Himachal Pradesh State legislative assembly during the budget session. Already a vigilance inquiry has been initiated.
{{/usCountry}}Chief minister Sukhvinder Singh Sukhu flagging “irregularities” in the HIMACRE scheme had announced its replacement with an insurance-based model in March this year in the Himachal Pradesh State legislative assembly during the budget session. Already a vigilance inquiry has been initiated.
{{/usCountry}}Moving towards ensuring that the new scheme is rolled out in November, the Health Department has finalized the Standard Operating Procedure (SOP) for the scheme’s implementation and preparations are underway to invite applications from insurance companies. The scope of treatment has been expanded in the new scheme, which includes 280 essential medicines. Additionally, provisions have been made to include all types of surgical procedures under the insurance coverage.
This will provide patients with relief from the substantial hospital expenses incurred during serious illnesses or surgeries. The government aims to provide cashless and superior healthcare facilities to eligible families through this scheme. The state government has completed all preparations for the new health insurance scheme, and tenders will be invited from companies this month.
The new scheme encompasses various aspects, including treatment for beneficiaries, hospital empanelment, claim settlement, coverage for medicines and surgeries, and a monitoring mechanism.
Uproar on scheme during monsoon session
The Mukhya Mantri Himachal Health Care Scheme (HIMCARE) was launched in the state in January 2019. Under the scheme, eligible people can avail cashless treatment coverage of up to ₹5 lakh per year per family in empanelled hospitals.
The BJP had accused the state government of closing the scheme. The issue had led to uproar in the recently concluded Monsoon Session of state legislative assembly.
Leader of opposition, Jai Ram Thakur had gone on to say that Congress government was “strangulating” flagship health schemes Himcare scheme.
Responding to the debate during the recently concluded Monsoon session even Health Minister Dhani Ram Shandil had clarified that Himcare was a useful scheme and maintained that the government had no intention of stopping them.