AYUSHMAN BHARAT SCHEME: Bogus bills and fake admissions, Uttar Pradesh private hospitals inject fraud, get caught
Some private hospitals in Uttar Pradesh are raising bogus inflated bills under the Ayushman Bharat scheme to make easy money, according to reports. In one instance, a diarrhoea patient admitted to a general ward was shifted to intensive care, his photo was taken, and he was then moved back to the general ward. The hospital could earn more money through the scheme by raising ICU bills instead of general ward bills. So far, 369 private hospitals have been de-empanelled from the scheme due to fraudulent acts. The government is implementing new methods to catch fraudsters.
A diarrhoea patient admitted in the general ward with normal vitals was shifted to the intensive care unit (ICU), his photos were clicked and he was swiftly shifted back to the general ward.
Reason: The hospital could earn more via Ayushman Bharat scheme by raising ICU bills instead of those for the general ward.
This is just one instance among the 160 such cases that have come to light wherein some private hospitals in Uttar Pradesh raised bogus inflated bills under the Ayushman Bharat scheme to make easy money. Five of these cases were from Lucknow.
In the instance cited above, treatment could have been done for about ₹2500 per day but with bills claiming ICU facility, the amount goes beyond ₹7000 per day.
“Obnoxious for the patient, the act was done by the hospital just to earn more via Ayushman Bharat scheme. We have a robust screening with AI (artificial intelligence) supported software to catch fraudsters,” said Sangeeta Singh, CEO Sachis (State Agency For Comprehensive Health and Integrated Services) that’s monitoring implementation of the Ayushman Bharat scheme in the state.
While U.P. government is focusing on increasing the number of hospitals where patients can get treatment under the Ayushman Bharat scheme, it seems select private hospitals are getting newer ideas for fraud.
Till now, 369 private hospitals have faced action of de-empanelment from the Ayushman Bharat scheme after instances of various types of fraud were detected.
“That’s why we are putting up new methods to catch them. Hospitals are being caught and de-empanelled when found guilty followed by recovery of any amount paid to them in fraud cases,” said Sangeeta Singh.
The available statistics show that 23% or 369 out of the 1610 private hospitals empanelled under the Ayushman Bharat scheme since inception were thrown out of the scheme following fraudulent acts and the latest action was taken in Amethi on Thursday.
A private hospital in Amethi was sealed by the administration following the death of a woman patient and deputy chief minister Brajesh Pathak instituted a probe into the death. The chief medical officer cancelled the registration of the hospital and hence it was de-empanelled by Sachis.
In another case, patients were treated like sheep in Kanpur where dozens of patients operated on by ophthalmologist were sent back home in a van soon after surgery.
“We got the cases checked and found proper hospital stay, as required, was not allowed and the patients were transported just as animals are. Immediately, we cancelled empanelment and rejected bills,” Singh said.
In another instance of fraud, a doctor was shown treating patients at two different hospitals at the same time. The Sachis team checked the distance between the two hospitals and found it was not possible to remain present at these two places simultaneously at one time.
“When checked, the doubt was found correct. Hence, action, too, came,” said Singh.
At present, the process of de-empanelment is in the pipeline for another six hospitals.
Among many reasons for de-empanelment are financial irregularities (25 hospitals), duplicate entry (01), non-performance under scheme (285), cancellation of the hospital’s registration with the district health department (18), self-withdrawal (38) and wrongly or faulty empanelment (01).
“We are continuously watching and upgrading our screening software and checkpoints. We want to have only those hospitals with us which can deliver health facility genuinely,” said Singh.
Apart from the private hospitals, government hospitals too are empanelled for treatment to Ayushman Bharat beneficiaries.
Sachis has also put 88 private hospitals under watchlist. Those under watch list have to go through rigorous screening for each bill they produce. Their bills are verified and even cross checked with patients via telephone or in person meeting by Sachis team members and only then a bill gets cleared.