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A report by the Comptroller and Auditor General (CAG) has shed light on a number of irregularities in the implementation of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY). CAG’s audit report on Ayushman Bharat presented in Parliament on Monday revealed that nearly 7,50,000 beneficiaries of the PMJAY are registered under a single mobile number – 9999999999.
The case is not isolated. More than 139,000 beneficiaries are associated with the mobile number 8888888888, while over 96,000 beneficiaries are connected to 9000000000, the report said. Additionally, the report indicated that around 20 other mobile numbers have between 10,000 to 50,000 beneficiaries linked to them.
Launched in 2018, the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana aims to provide health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to the poor and vulnerable section of the population, to improve affordability, accessibility, and quality of care for the poor and vulnerable section of the population.
“As per National Health Authority (NHA) records, 7.87 crore beneficiary households were registered, constituting 73 per cent of the targeted households of 10.74 crore (November 2022). In the absence of adequate validation controls, errors were noticed in the beneficiary database i.e. invalid names, unrealistic date of birth, duplicate PMJAY IDs, unrealistic size of family members in a household etc. Ineligible households were found registered as PMJAY beneficiaries and had availed the benefits ranging between Rs 0.12 lakh to Rs 22.44 crore under the Scheme,” the report said.
Adding that mobile numbers are significant for searching records related to any beneficiary in the database, who may approach the registration desk without the ID. In case of loss of e-card, identification of the beneficiary may also become difficult.
“NHA, while agreeing with audit observation, stated (August 2022) that with the deployment of BIS 2.0, this issue shall be resolved. Further, the BIS 2.0 system has been configured so that more than certain number of families cannot use the same mobile number. This shall arrest the prevalence of entering “random numbers” which constitute the overwhelming cases of mobile number inconsistency,” the report said.
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Other Issues With PMJAY
The CAG report also showed instances where patients previously marked as dead were found to have continued receiving medical treatment under the scheme. Further data suggested that the same patient could get admission to multiple hospitals during the same period of hospitalisation.
“During desk audit (July 2020) audit had earlier reported to NHA that the IT system (TMS) was allowing preauthorization request of the patient who was earlier shown as ‘dead’ during her/his treatment availed under the scheme,” the report said.
“Data analysis during desk audit (July 2020) revealed that the IT system (TMS) did not prevent any patient from getting admission in multiple hospitals during the same period of hospitalisations…data analysis revealed that 78,396 claims of 48,387 patients were initiated in TMS where the date of discharge of these patients for earlier treatment was later than admission date for another treatment of the same patient,” the report further said.
According to a Bussines Today report, the CAG report was presented in Parliament, coinciding with MoS Health and Family Welfare SP Singh Baghel’s written response in the Rajya Sabha. Baghel said that the government employs artificial intelligence (AI) and machine learning (ML) to identify potentially fraudulent transactions within the AB-PMJAY scheme. He said that these technologies serve the purpose of preventing, detecting, and deterring healthcare-related fraud. The minister also disclosed that a total of 24.33 crore Ayushman Bharat cards have been generated under the scheme as of August 1, 2023.
The audit report also raised concerns about various shortcomings in the database, including invalid names, duplicate health IDs, incorrect entries in gender fields, unrealistic family sizes, and improbable dates of birth. Notably, the report highlighted that 18 Aadhaar numbers were associated with two registrations each in 36 instances, while in Tamil Nadu, seven Aadhaar numbers were linked to a staggering 4,761 registrations.
Deviation from Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) guidelines was another issue underscored by the report. It pointed out that certain empanelled health care providers (EHCPs) failed to adhere to prescribed quality standards and criteria crucial for the safety and welfare of beneficiaries, as well as for maintaining the required conditions for empanelment.
Numerous EHCPs faced shortages in doctors, infrastructure, and equipment. Additionally, some EHCPs did not meet the essential criteria for support systems, infrastructure, or quality standards outlined in the PM-ABJAY guidelines. The report also noted non-compliance with mandatory criteria by EHCPs in various states and union territories (UTs). This includes aspects such as infrastructure, fire safety measures, bio-medical waste management, pollution control, and the validity of hospital registration certificates. In specific cases, fire safety certificates had even expired before empanelment.
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