Government has zero tolerance for fraud in Ayushman Bharat scheme: Health Minister in Lok Sabha
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana has a zero tolerance policy for any kind of fraud and a three-tier grievance redressal system is in place at district, state and national levels to deal with such issues, the Lok Sabha was told. On Friday.
Responding to a question about unnecessary surgeries performed by hospitals included under the PMJAY-Ayushman Bharat Scheme in Gujarat, State Health Minister Prataprao Jadhav in a written reply said that a fire has been filed on November 12 against the hospital and the doctors involved.
Further, the hospital and the doctors concerned have been suspended from the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), he said.
The minister said that as of November 25, a total of 18,184 complaints have been registered in the system called Central Grievance Redressal and Monitoring System (CGRMS) related to issues such as denial of treatment, cost of admission, discharge or medication and unavailability of Pradhan Mantri. Arogya Mitra (PMAM), etc.
“AB-PMJAY ensures quality healthcare services to the beneficiaries of the scheme. The scheme is managed in a zero tolerance manner for any kind of fraud and abuse and various measures are taken to prevent, detect and curb various types of fraud that may occur in the scheme at different stages of its implementation,” said Jadhav.
The National Anti-Fraud Unit (NAFU) was established within the National Health Authority (NHA) and works in collaboration with the State Anti-Fraud Units (SAFU) to investigate and take joint action against matters related to fraud and abuse.
Appropriate actions, including suspension, show cause notice, warning letter for removal of hospitals, cancellation of e-cards, fine levied on errant hospitals and lodging of FIR are taken against the fraudulent organizations, he said.
Under AB-PMJAY, a three-tier grievance redressal system at district, regional and national level has been created to resolve the problems faced by the beneficiaries in availing health care, he said.
At each level, there is a dedicated officer and grievance redressal committees to deal with complaints. Beneficiaries can file their grievances using different channels, including the web-based portal Centralized Grievance Redressal Management System (CGRMS), central and state call centers, emails, letters to government health centers, etc.
Based on the nature of the complaint, necessary steps are taken to resolve it, including contacting the hospital and providing assistance to the beneficiaries in getting treatment under the scheme.
AB-PMJAY aims to provide a health cover of Rs 5 lakh per family per year for secondary care hospitalization and tertiary care to nearly 55 million beneficiaries corresponding to 12.37 crore families constituting the most economically vulnerable 40 percent of India’s population.
As of October 31, 2024, 35.8 crore Ayushman cards have been created under the scheme. As of December 2, 20.4 lakh Ayushman Vay Vandana cards have been created under the scheme, Jadhav said.
