Punjab Vigilance Bureau on Wednesday claimed to have unearthed a big scam worth crores of rupees under the Pradhan Mantri Jan Arogya Yojana – ‘Ayshmaan Bharat’ scheme, in which the State’s private hospitals have obtained health insurance claims from insurance company, IFFCO-TOKIO, on the basis of “fake bills” for treatment of beneficiary patients possessing smart health cards.
Contrary to this, the IFFCO-TOKIO had rejected hundreds of insurance claims pertaining to Government hospitals causing a huge loss to the state exchequer. “On the basis of inputs received from credible sources, it has come to light that several well-known private hospitals — based in Jalandhar, Hoshiarpur, and Kapurthala districts — have prepared hefty fake bills on the names of smart card holders for their treatment under Ayushman Bharat scheme and took insurance claims from IFFCO TOKIO,” said the state DGP-cum-Chief Director Vigilance Bureau BK Uppal.
He said that a regular vigilance enquiry have been registered by the Bureau to investigate this scam worth crores of rupees in the State.
Giving details of the preliminary findings, Uppal said that Vigilance Range, Jalandhar, SSP Daljinder Singh Dhillon have unearthed this fraud in which several fake medical bills of private hospitals had been cleared by the insurance company, while the reimbursement bills forwarded by the Government hospitals were rejected.
“In this connection, major negligence has been seen at the end of concerned Deputy Medical Commissioners and doctors of the state hospitals or primary health centres,” he said.
The major reason for rejecting the insurance claims of government hospitals by the company was to get extraordinary financial benefits of Rs 52,06,500. “As a result, the Punjab Government has incurred a total financial loss of to the state exchequer during the last one year from these three aforesaid districts,” said Uppal. During investigations, it has came to light that a well known hospital of Sultanpur Lodhi in Kapurthala district had claimed Rs 4,43,98,450 for the treatment of about 1,282 patients. Out of these, 519 claims have been rejected.
“On the basis of these medical bills, Punjab State Health Authority has passed claims of this Hospital to the tune of Rs 4,23,48,050. Then, IFFCO TOKIO insurance company reimbursed the claimed amount to the tune of Rs 1,86,59,150 to the said hospital,” said Uppal.
Revealing the modus operandi of the administration of the hospital under investigation (name withheld not to hamper investigations), the Vigilance chief further informed that a patient named Paramjeet Kaur of Turna village in Jalandhar district was admitted to the hospital for operating gall bladder stone but due to her personal reasons, she did not undergo the operation.
“In this regard, the hospital prepared a fake medical bill of Rs 22,000 for this patient and took reimbursement claim form IFFCO-TOKIO under the Ayushman Bharat health insurance scheme,” he said.
Citing another case, Uppal said one Sukhjinder Kaur of Sidhupur village was admitted to the same hospital for gall bladder operation. “She presented her smart health card issued by the Punjab Government, but the Hospital director asked the patient that her treatment could not be done with one smart card. The hospital director then told the patient to either deposit Rs 25,000 in cash or bring six-seven smart cards to avail the benefit of treatment. After this, Sukhjinder’s family submitted three smart cards belonging to her family members to the hospital,” he said.
Uppal said that to cover up the “fraud”, the Hospital shoot fake videos of Sukhjinder’s family members lying on hospital beds and took their signatures on blank papers. “The Hospital administrator also instructed them to reply on receiving a phone call by saying that they underwent an operation. But all three of them had no ailment,” said Uppal adding that the hospital claimed falsely Rs 25,000 each of three persons for operating only Sukhjinder Kaur which raised the suspicion that the Ayushman Bharat scheme was being rigged on a large scale by this hospital.
As per reliable input and figures, as many as 4,828 claims of 77 private hospitals were rejected during the last one year by the IFFCO-TOKIO health insurance company. The amount of rejected insurance claims of private hospitals is approximately Rs 5,59,96,407.
The VB has also learnt that 1,015 claims, of approximately Rs 52,06,500, of 35 Government hospitals were rejected during last one year by IFFCO-TOKIO.
“A vigilance enquiry has been registered to probe this scam in depth and to expose the irregularities being committed by the private hospitals in the State for achieving massive financial gains,” he said.