E-Paper
1,000 hospitals faced action for AB-PMJAY scheme irregularities
AB-PMJAY was launched in 2018 to provide ₹500,000 annual cashless health insurance cover to eligible citizens for treatment in hospitals across the country.
More than one thousand hospitals across the country have faced actions, ranging from de-empanelment and levying of fines, in connection with irregularities while implementing the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) since the launch of the scheme, according to the data shared by the Union health ministry in Parliament on Friday.
Suitable actions including de-empanelment of 1,114 hospitals, imposition of penalties worth ₹122 crore on 1,504 errant hospitals and suspension of 549 hospitals have been taken against fraudulent entities as reported by the states and Union Territories, the ministry said in a written reply in the Lok Sabha.
AB-PMJAY , a flagship scheme of the central government, was launched in 2018 to provide ₹500,000 annual cashless health insurance cover to eligible citizens for treatment in hospitals across the country.
“Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY) is governed on a zero-tolerance policy towards misuse and abuse and various steps are taken for prevention, detection and deterrence of different kinds of irregularities that could occur in the scheme at different stages of its implementation. A robust anti-fraud mechanism has been put in place and National Anti-Fraud Unit (NAFU) has been set up with the primary responsibility for prevention, detection and deterrence of misuse and abuse under AB-PMJAY,” the ministry said.
According to the terms and conditions of empanelment, hospitals cannot deny treatment to eligible beneficiaries of the scheme. In case of denial of treatment by the empaneled hospital, beneficiaries can lodge grievances. Under AB-PMJAY, a three-tier grievance redressal system has been created at district, state and national level to resolve the issues faced by beneficiaries in utilising healthcare services. At each level, there is a dedicated nodal officer and grievance redressal committees in place to address the grievances of beneficiaries.
“Settlement of claims is an ongoing process. Under AB-PMJAY, claims are settled by respective State Health Agencies (SHA). The National Health Authority (NHA) has laid down guidelines for payment of claim to hospitals within 15 days of claims submission for the intra-state hospitals (hospitals located within state) and within 30 days in case of portability claims (hospitals located outside state),” the ministry said.
“Regular review meetings are organised to take stock of the progress with regards to the claims. Further, capacity building activities are organised for efficient claims settlement,” it added.
