Gujarat PMJAY Fraud: Four More Hospitals Face Action (image:pixabay)
Ahmedabad, Gujarat: The Gujarat government has taken action against four more hospitals in the State for alleged irregularities under the Pradhan Mantri Jan Arogya Yojana —Mukhyamantri Amrutam (PMJAY-MA) scheme. As per government’s crackdown, the empanelled hospitals under the project are being closely observed to ensure that patients receive proper treatment. Launched in July last year, Gujarat’s PMJAY-MA is a revised health insurance scheme merging Centre’s PMJAY, popularly known as Ayushman Bharat and state government’s MA scheme.
The State Anti-Fraud Unit’s (SAFU) drive, comprising a team of expert doctors, visited suspected hospitals across Gujarat. The latest hospitals that have faced action are Krishna Surgical Hospital (Rajkot), Swastik Multispeciality Hospital (Rajkot), Jayaben Modi Hospital (Bharuch), and Bankers Super Speciality Hospital (Vadodara). With this, the total number of hospitals faced action as part of this drive in the financial year turned to 16.
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The Gujarat government started the inspections on the hospitals in the light of two major rackets came earlier this year – the admissions of healthy newborns at Nihit Babycare Children Hospital in Rajkot and the death of two men following alleged unnecessary angioplasty surgeries at Khyati Multispeciality Hospital in Ahmedabad, the Indian Express reports. Officials stated that both cases emerged from false claims made on the basis of tampered and forged medical records of patients.
In Swastik Multispeciality Hospital, an audit conducted by the insurance company empanelled as part of the scheme found tampering in the USG (Ultrasound Sonography) plates and HPE (Histopathological Examination) reports in a total of 196 cases. The hospital has been suspended and a penalty of Rs 2.94 crore was imposed. Dr Rajesh Kandoriya, the gynaecologist associated with the irregularities, was blacklisted from the scheme.
The SAFU located several issues in Krishna Surgical Hospital including infrastructure, cleanliness, and manpower. The hospital’s Building Use (BU) Certificate and Fire Safety Certificate (FSC) has expired and it did not posses certificate from the Atomic Energy Regulatory Board (AERB) which important when X-ray equipment is installed at the hospital. The hospital has been suspended from PMJAY-MA until further notice.
Jayaben Modi Hospital committed irregularities in the signature and stamps in the Tumour Board Certificate (TBC) uploaded in the software. Rs 33.44 lakh will be recovered by the State Health Agency (SHA), and the State Grievance Redressal Committee (SGRC) will consider penalty regarding the upcoming SGRC (State Grievance Redressal Committee).
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During the drive, Bankers Super Specialty Hospital found to be violating Ayushman Yojana guidelines in the oncology surgery packages. The State Health Agency (SHA) will recover Rs 57.51 lakh, while the penalty will be decided later.
Meanwhile, the health department informed that the Gujarat government has prepared new guidelines (SOPs) for treatment under the PMJAY-MA scheme, including for cardiology and cardiovascular surgery, radiotherapy and neonatal care, which are planning to be announced soon.
