5 Gujarat hospitals debarred under PMJAY due to alleged irregularities: Health dept

Two doctors working in these hospitals were also suspended from providing services under PMJAY - a flagship health insurance scheme.

Ahmedabad: The health department in Gujarat has debarred five hospitals and two doctors from participating in the Pradhan Mantri Jan Arogya Yojana (PMJAY) and Maa Yojana after an inspection of the facilities indicated multiple irregularities, a state government statement said on Monday.

Five empanelled hospitals -- two in Patan district, one each in Dahod, Ahmedabad and Aravalli districts -- and two doctors were suspended under PMJAY in the last one week for irregularities, the health department said (FILE PHOTO/Representative Image)

Between December 2 and December 8, the State Anti-Fraud Unit (SAFU), working alongside expert doctors, conducted thorough inspections of suspected facilities.

Their investigations indicated various fraudulent activities, including manipulated laboratory reports, inadequate infrastructure, and violations of scheme guidelines.

Since January 2024, the health department has suspended a total of 12 hospitals for violating PMJAY guidelines.

“We will not tolerate inhumane activities by hospitals and doctors exploiting this scheme for financial gain. Strict actions will continue against those found guilty,” said an official.

The Gujarat government is also developing new Standard Operating Procedures for treatment protocols under PM-JAY, covering crucial areas such as cardiology, radiology, chemotherapy, and neonatal care, said officials.

Officials said investigators alleged tampering in 91 lab reports during pre-authorization at Hir Hospital in Patan, with inflated charges for neonatal care.

The hospital, along with its on-duty doctor Dr Hiren Patel and affiliated Health Spring 24 Pathology Laboratory, was suspended from the scheme and ordered to refund Rs. 50.27 lakh, the statement said.

The empanelment of Nishka Children’s Hospital in Patan with PMJAY was also suspended over allegations that 60 lab reports were either missing or tampered with.

The facility, its on-duty doctor Dr Divyesh Shah, and the associated Shiva Diagnostic Laboratory were suspended, and an order to recover ₹15.16 lakh in penalties and recovery amount was issued.

Dahod’s Sonal Hospital was also taken off the list of empanelled hospitals on charges that it had failed to maintain adequate manpower, infrastructure, and infection control measures as required by the scheme guidelines.

Centara Orthopedic Hospital in Ahmedabad was suspended for operating its fourth and fifth floors without proper permissions and lacking essential facilities, including a modular operation theatre and sufficient staff.

Shri Jalaram Children’s Hospital in Aravalli was suspended due to an expired fire safety certificate and non-compliant neonatal intensive care unit (NICU).

The SAFU team is intensifying its audits across the state, examining records and ensuring compliance with scheme guidelines.

The move comes nearly a month after two patients died at Khyati Multi Speciality Hospital after undergoing angioplasty procedures.

It was alleged that villagers were brought for angiography to exploit health insurance coverage under PMJAY Of the nineteen villagers, twelve underwent angiography procedures, and seven were subjected to angioplasty, leading to the two fatalities.

So far seven persons including the founder director Dr Sanjay Patoliya have been arrested in the case.