Context:

Recently, the Comptroller and Auditor General of India (CAG) has highlighted irregularities in the registration and validation of beneficiaries under the Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (PMJAY).

About Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY):

• Universal Health Coverage: PMJAY was launched as a step towards Universal Health Coverage (UHC). The concept covers three key elements — access, quality, and financial protection.
• Aim: To reduce out-of-pocket expenditure for the poor and vulnerable population seeking healthcare

Issues highlighted in the report:

• Payment for Deceased Patients: The CAG revealed that Rs 6.97 crore was paid for the treatment of 3,446 patients who were previously recorded as deceased in the database.
  • Patients declared as “dead” in the Transaction Management System (TMS) of the scheme continued to avail treatment benefits.
  • Kerala had the most number of such “dead” patients – 966 – whose claims were paid.
• Flawed Application System: The CAG identified flaws in the system where patients who were earlier recorded as dead were still able to initiate pre-authorizations and claim submissions.
  • This exposed vulnerabilities in the application system that could be misused.
• Multiple Hospital Admissions: The audit report highlighted cases of the same patient being admitted to multiple medical institutions simultaneously.
  • The report noted 78,396 such instances, indicating potential issues related to proper record-keeping and implementation oversight.
  • Gujrat reported the most cases (21,514), followed by Chhattisgarh (9,640) and Kerala (9,632).
• Inadequate Recovery of Penalties: In some states, including Chhattisgarh, Meghalaya, and Madhya Pradesh, the recovery of penalties was found to be inadequate.
  • Despite penalties being imposed on defaulting hospitals, the recovery process was not consistently effective.
  • Out of Rs 17.28 crore penalty imposed on 184 defaulting hospitals in 13 States, recovery of only ₹ 4.96 crore had been done.

News Source: The Indian Express