CAG Exposes AB-PMJAY, INR 6.9 Cr Paid for Already Declared Dead Patients’ Treatment
CAG uncovered irregularities in the AB- PMJAY exposing payments of INR 6.9 Cr for treating already declared dead people.
CAG Exposes Ayushman Bharat Scheme- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), INR 6.9 Crore Paid for Dead Patients’ Treatment
The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) health insurance program has been implemented with major errors, according to a shocking finding from the Comptroller and Auditor General of India (CAG). The effectiveness of the scheme, which was introduced in 2018 with an ambitious objective of being able to offer financial assistance to the under-privileged as well as vulnerable population in search of medical care in both urban and rural regions, is now in doubt after the CAG’s audit revealed payments totalling INR 6.97 crore for the medical treatment of 3,446 patients who had previously been recorded as dead according to the scheme’s database.
Payment for Deceased Beneficiaries Raises Alarms
The treatment of a beneficiary recorded as “dead” during previous claims and treatment procedures has been the primary focus of the CAG’s performance audit. Patients who had previously been listed in the Transaction Management System (TMS) of the system as deceased continued to get care and were even paid for it, in accordance to the audit. This defect not only calls into question the dependability of the scheme, but it also draws attention to a systemic deficiency that permitted payments like these to take place.
Failure to Implement Corrective Measures
The CAG’s examination revealed that despite promises of corrective action, the system did not stop patients who had been designated as deceased from receiving care under the PMJAY plan. In cases of mortality, the recommendations prescribed explicit payment systems, including audits for patients who pass away while being treated in a hospital. The audit’s conclusions, however, showed that these rules were not consistently followed.
Geographical Distribution of Irregularities
The anomalies were not limited to a single region. The audit uncovered incidences of this sort in every one of the states, particularly Chhattisgarh, Haryana, Jharkhand, Kerala, as well as Madhya Pradesh having the largest number of these kinds of incidents. Andaman and Nicobar Islands, Assam, Chandigarh, Manipur, and Sikkim, on the other side, had the fewest such occurrences.
System Vulnerabilities and Misuse
The CAG found that the system not only facilitated back-dating of admissions but additionally allowed entries for admission dates, operation dates, as well as days of discharge for patients who had previously been listed as deceased, underscoring yet another flaw in the system as a whole. The National Health Authority (NHA) gave operational justifications for this backdating provision, but the CAG found these justifications to be insufficient, claiming that these flaws made the system vulnerable to abuse as well as erroneous payments.
Flaws in Registration and Validation of Beneficiaries
The thorough examination of the AB-PMJAY database by the Comptroller and Auditor General of India has unveiled substantial shortcomings in addition to the previously mentioned treatment payment irregularities. The report brings to light significant issues in the registration as well as validation of beneficiaries within the scheme.
Overlapping Registrations and Invalid Mobile Numbers
The registration of several beneficiaries under the same mobile number is one of the facts which ought to bring concern about the scheme the most. According to the CAG study, a startling 7.49 lakh beneficiaries had been enrolled under the PM-JAY program using the mobile number ‘9999999999’, while nearly 9.85 lakh people have been registered with the same mobile number, ‘3’.
In addition to this, several people have made use of mobile numbers like “8888888888,” “9000000000,” “20,” “1435,” and “185397” for this reason. The Beneficiary Identification System (BIS) database examination revealed a sizable number of beneficiaries, with numbers ranging from 1,119 to 7,49,820 beneficiaries, whose identities were associated with a single or invalid mobile number, according to the report.
Multiple Database Faults Detected
The CAG report also calls attention to a number of other problems with the AB-PMJAY database in addition to the problem of duplicate mobile numbers. These include entries with illegitimate names, duplicate health IDs, inaccurate gender information, unusual dates of birth, as well as unreasonably huge families. According to the report, registrations made using Aadhaar numbers can also contain duplicate information. In Tamil Nadu, 4,761 registrations using seven Aadhaar numbers along with 36 instances of dual registrations using 18 Aadhaar numbers were found.
Negligence in Adherence to Guidelines
The report goes into further detail on the carelessness that certain empanelled healthcare providers (EHCPs) engaged in while operating under the AB-PMJAY system. It demonstrates how they fall short of the requirements for prescribed quality standards as well as criteria, which are necessary to guarantee the security and welfare of beneficiaries and to fulfill the minimal requirements for empanelment.
Inadequate Infrastructure and Equipment
The audit revealed that certain EHCPs had a lack of critical resources, including infrastructure, medical professionals, as well as essential equipment. These service providers did not adhere to the quality standards and criteria required by the PM-ABJAY guidelines and did not meet the minimal requirements for infrastructure as well as assistance systems required to be met as per the scheme.
Guideline Breaches in Several States and Union Territories
The research also draws attention to the fact that EHCPs in several states and union territories failed to completely comply with requirements relating to hospital registration certificates, bio-medical waste management, infrastructure, fire safety measures, as well as pollution control. Some fire safety certificates had already expired when the empanelment process began, raising questions about whether fundamental safety procedures had been followed.
Analysis: A Multifaceted Crisis
The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is experiencing a deeper crisis as a result of the CAG report’s discoveries than the initial issues with treatment payment discrepancies. The difficulties vary from problems with data integrity to service providers not meeting quality and safety requirements, casting skepticism on the overall success of the plan.
Restoring the scheme’s credibility and maintaining its success in providing affordable and high-quality healthcare to India’s poor people would depend critically on dealing with these complex issues. The report’s conclusions highlight the urgent need for thorough reforms as well as stringent oversight to address these issues and maintain the program’s original goals.
Call for Intensive Investigations and Greater Oversight
The CAG’s report has recommended thorough investigations by the National Health Authority (NHA) as well as State Health Agencies (SHA) to mitigate the risks which are connected with irregular payments and potential misuse of the system. At a time when the government’s commitment to delivering affordable and accessible healthcare to the most vulnerable section of the population is of paramount importance, these revelations highlight the need for stringent scrutiny along with heightened oversight in the successful implementation of such essential schemes like PMJAY.
Charting a Way Forward: Rectifying AB-PMJAY’s Challenges
The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY), which was introduced as a ground-breaking program to ease the financial burden on economically disadvantaged people seeking medical care, is now dealing with significant criticism as a result of the findings of the CAG’s audit. The investigation is intended to be an alarming reminder for addressing the evident faults with the scheme’s execution as the government struggles to provide high-quality healthcare to the nation’s disadvantaged. It is essential that thorough steps be taken to address the system’s flaws and regain the public’s trust in this crucial healthcare project.
The need of rectifying the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana’s (AB-PMJAY) numerous problems has been underlined by the discoveries made by the Comptroller and Auditor General of India about the scheme. The program was started with the noble goal of giving the most under-privileged people of India the opportunity to receive affordable healthcare, but it is impossible to overlook the problems with data integrity, implementation, as well as provider adherence. To ensure both the effectiveness and legitimacy of the AB-PMJAY initiative, certain essential steps must be performed as India works towards achieving significant advancements with regard to healthcare services-
- Strengthening Data Integrity and Validation Processes- It is crucial to address the problems brought on by duplicate beneficiary registrations and incorrect data. Errors and duplication can be reduced by putting in place strong data validation processes and developing a centralized system to check and identify beneficiaries. By ensuring that those who actually require assistance are the ones receiving it, this would help to focus on healthcare resources and benefits more precisely.
- Enhancing Provider Compliance and Oversight- Disturbing instances of empanelled healthcare providers (EHCPs) failing to meet quality norms and requirements have been brought to light in the CAG report. Beneficiaries can be guaranteed to receive care from qualified and accountable providers by enhancing monitoring measures, carrying out regular audits, and applying strong penalties for non-compliance. The overall healthcare experience according to the plan can be considerably improved by putting more of an emphasis on quality than quantity.
- Implementing Real-Time Auditing and Controls- Real-time auditing of treatment claims as well as payments can stop future instances of paying beneficiaries who have passed away. With the development of technology, it is now possible to create safeguards that instantly alert users to inconsistencies and other anomalies in claims, enabling prompt correction.
- Strengthening Guidelines and Training- Clearer instructions for EHCPs as well as beneficiaries alike can be obtained by revisiting and improving the rules for filing claims, carrying out treatments, and registering beneficiaries. By providing thorough training and awareness programs, you can make sure that all stakeholders are aware of the rules and procedures under AB-PMJAY, lowering the possibility of mistakes.
- Collaborative Efforts and Transparency- It is crucial to improve cooperation between the State Health Agencies (SHA), the National Health Authority (NHA), as well as other stakeholders. An enhanced healthcare delivery ecosystem can result from the sharing of best practices, problems, and solutions through an open and transparent communication channel.
The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has the enormous potential to improve the lives of millions of people by giving them access to vital healthcare. However, the most recent audit has shown a number of problems that require quick attention and correction. Under AB-PMJAY, addressing issues with data integrity, provider compliance, auditing procedures, standards, as well as promoting collaboration can all contribute to the development of a more effective and efficient healthcare delivery system. The lessons learnt from these difficulties must be adopted as India moves closer to providing affordable, high-quality healthcare, in order to create a stronger and more durable health care security net for the nation’s most vulnerable inhabitants.
