TNN Updated: Aug 10, 2019, 03.22 PM IST
About a year after introduction of the Ayushman Bharat scheme — the Union government’s programme for providing health protection cover to around 10 crore vulnerable families — truant doctors and hospitals in the tiny Himalayan state of Uttarakhand have come up with some of the most innovative ways of scamming the ambitious plan for a quick buck. Not that they haven’t been caught. But the string of frauds has put officials on a state of perpetual alert.
Private hospitals have been accused of siphoning almost Rs 1.20 crore of public funds in just a few months. And they seem to have done it in bizarre ways — from showing surgeries being conducted on patients who had actually been discharged days ago, to dialysis shown as having been performed in a facility where there was no kidney specialist.
In fact, quite a few hospitals in the hill state showed patients to be afflicted with deadly diseases while they were later found to have been suffering from common cold. Some hospitals showed operations done on patients whose surgeries had already been completed elsewhere. Yet others claimed money by submitting records of surgeries done on patients who were perfectly healthy.
Sample this. When a team of the National Health Authority (NHA), which visited Uttarakhand in May for a physical verification of beneficiaries, met a patient, they were in for a surprise. The man was listed as someone who needed emergency hip replacement surgery. But he was merrily driving around on a scooty.
“How can a person who needs emergency hip replacement drive a two-wheeler? The hospital had claimed Rs 90,000 for the surgery which was declined by us,” said Abhishek Tripathi, director, Atal Ayushman Yojana (Uttarakhand).
Vinod Ortho Clinic in Dehradun, the medical facility which had recommended the surgery, was allegedly also involved in another dubious case.
A patient whose limbs had already been amputated was shown as having undergone a similar surgery in the clinic though it was later found he had been admitted there only after a minor infection. The clinic has since been deempanelled.
When TOI spoke to the clinic’s owner, Dr Prasoon Maheshwari, he said he hadn’t done anything wrong. “I’m planning to move court to challenge the action taken by Atal Ayushman authorities,” he said and added that he was targeted because “many renowned doctor were having a problem with the fact that patients had started coming to me instead of them”.
Uttarakhand has over 150 hospitals empanelled under the scheme. Although it started out last year in September as Ayushman Bharat covering around 5.37 lakh beneficiaries, its scope was extended by the BJP government to bring more people under its umbrella. Chief minister Trivendra Singh Rawat announced in December last year that the scheme would be named Atal Ayushman Yojana in Uttarakhand and and will cover around 18 lakh more beneficiaries besides the ones identified earlier under the central plan. The state is footing the bill for the additional beneficiaries, each of whom is entitled to medical cover of Rs 5 lakh.
Perhaps it is this blanket extension of the scope of the scheme, although well-intended, that has led to it being open to fraud. During screening of claims that started in March this year, officials came across case after case of alleged swindling. It led to seven hospitals being de-empanelled for forgery; FIRs were filed against four and 12 others were issued show-cause notices for “gross irregularities”.
A member of the probe team said, “A 30-bed hospital in Kashipur claimed to have 24x7 emergency facility. But it was manned by just one doctor who was also the owner. The hospital had made medical claims of Rs 2,72,600 which were cancelled after scrutiny.”
In a primary health centre in Udham Singh Nagar, a pharmacist was referring patients to private nursing homes. One of the nursing homes had employed an Ayurvedic doctor and showed him as an MBBS degree-holder. The nursing home was also found showing common fever patients as suffering from fatal diseases.
Investigators found that hospitals had devised another method to get more money. A hospital in Haridwar, for instance, filed a claim for performing 38 cataract surgeries in 45 days, all ..
Investigators found that hospitals had devised another method to get more money. A hospital in Haridwar, for instance, filed a claim for performing 38 cataract surgeries in 45 days, all of which were done after 9.30 pm and classified as “emergency”. The claim was rejected as cataract is not an emergency surgery.
Another Haridwar-based hospital had forged patients’ medical history in 152 cases. The hospital, officials said, had got empanelled in the Atal Ayushman scheme by showing itself ..
“They fraudulently converted general diseases into fatal ones and siphoned over Rs 10 lakh. The hospital also discharged 12 patients directly from the ICU which is not possible because patients have to be kept under observation after shifting from ICU. This hospital also filed claims of 12 surgeries done in 14 hours which were all attributed to the same doctor which again is not possible,” Tripathi said.
Although TOI contacted all the hospitals whose cases are mentioned in this report, no response was forthcoming. One of the hospitals that responded said speaking to media will be “violation of MoU signed under the scheme”. Elaborating, Dr Santosh Srivastava of MP Memorial Hospital, Kashipur, under the scanner for performing dialysis on over 1,000 patients over six months without any nephrologist, said the MoU signed between Atal Ayushman Society and the hospital has a clause that no party can speak to the media unless the process of de-empanelment is done.
“If the Atal Ayushman authorities are speaking to the media and disclosing the names of hospitals to whom notices were served, this is a gross violation of the MoU,” he alleged.