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After Khyati scam, Gujarat announces SOPs for hospitals empanelled under PMJAY
Gujarat health minister Rushikesh Patel said that all aspects have been considered while creating the new guidelines to ensure there’s no scope for malpractice or criminal activities
The Gujarat government on Monday announced new Standard Operating Procedures (SOPs) for hospitals empanelled under the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme for people with low income.
The guidelines come in the wake of the Khyati Multi-Speciality Hospital scam related to unnecessary medical procedures for insurance claims under the PMJAY insurance scheme. The procedures included angioplasties and allegedly led to the deaths of at least two patients in November.
The new guidelines, announced by health minister Rushikesh Patel on Monday, focus on cardiology, oncology, and neonatal care services.
“All aspects have been considered while creating the new guidelines to ensure there’s no scope for malpractice or criminal activities,” Patel media persons in Gandhinagar.
In 2024 alone, over 14 hospitals have faced suspension, de-empanelment, or penalties for violations, resulting in fines totaling approximately ₹18 crore, he said.
A major reform introduced through the Clinical Establishment Act-2024 makes it mandatory to obtain video-recorded consent from patients and their relatives while explaining pre-defined treatment procedures. This requirement applies to various major procedures including angiography, angioplasty, organ transplants, and cancer surgeries, adding transparency to the consent process, the minister explained.
The new guidelines introduce several stringent measures across different medical specialties. For cardiology services, hospitals must now maintain a full-time staff of cardiologists and cardiothoracic surgeons. This requirement aims to ensure that critical decisions about patient care are made by qualified specialists rather than general practitioners.
In oncology care, the guidelines mandate the formation of tumor boards comprising medical, surgical, and radiation oncologists. These boards must collectively determine treatment plans for cancer patients, ensuring comprehensive care protocols. For specialized treatments like brachytherapy, particularly crucial for certain women’s cancers, hospitals must have in-house facilities rather than relying on tie-ups with other institutions, the government said in a statement.
Neonatal care units face enhanced scrutiny under the new rules. Hospitals must install CCTV cameras in neonatal intensive care units while maintaining patient privacy. Full-time pediatricians are now mandatory, and nursing staff requirements are tied to the number of patient beds. There has to be regular monitoring by taluka health officers as per the new guidelines.
The new guidelines also mandate that hospitals must provide all diagnostic reports, including laboratory and radiology reports, along with the discharge summary when releasing patients. All hospitals in the state must strictly follow the Government of India’s guidelines for infection control and prevention, as per the press statement.
For monitoring purposes, the state has established a State Anti-Fraud Unit (SAFU). As of December 4, 2024, the PMJAY-MA scheme has processed over 72.79 lakh claims, disbursing Rs. 15,562.11 crore, said officials. Between July 2023 and July 2024, 24,701 claims worth Rs. 41.18 crore were rejected, and deductions worth Rs. 121 crore were made in 1,16,266 cases, they added.
Patient feedback through the 104 helpline between November 2023 and November 2024 showed 99% positive responses from the 4,96,184 patients contacted, with only 0.3% reporting negative experiences and 0.6% giving moderate feedback, according to the release.
The healthcare initiative, which originated as the “Ma” scheme launched by then-Chief Minister and current Prime Minister Narendra Modi to protect poor and middle-class families from debt due to sudden illness, was later expanded nationwide as the Pradhan Mantri Jan Arogya Yojana after he assumed the role of Prime Minister, it said.
