(Chd,Pb)Pb Vigilance Bureau Exposed Big Scam in PMJAY Scheme
Punjab Vigilance Bureau has exposed a big scam worth crores of rupees under the Pradhan Mantri Jan Arogya Yojana – ‘Aushmaan Bharat’ scheme in which private hospitals have obtained health insurance claims from insurance company named IFFCO TOKIO on the basis of fake bills for treatment of beneficiary patients possessing smart health cards. Contrary to this, the IFFCO TOKIO had rejected hundreds of insurance claims pertaining to government hospitals causing a huge loss to the state exchequer.As per DGP-cum-Chief Director Vigilance Bureau BK Uppal several well known private hospitals based in Jalandhar, Hoshiarpur and Kapurthala districts have prepared hefty fake bills on the names of smart card holders for their treatment under Ayushman Bharat scheme and took insurance claims from IFFCO TOKIO
A well known hospital of Sultanpur Lodhi town in Kapurthala district had claimed Rs. 4,43,98,450/- (Four crore forty three lacs ninety eight thousand four hundred fifty rupess) for the treatment of about 1,282 patients and out of which 519 claims have been rejected. On the basis of these medical bills, State Health Authority, Punjab have passed claims of this hospital to the tune of Rs. 4,23,48,050 (Four crore twenty three lacs forty eight thousand fifty rupess). Then IFFCO TOKIO insurance company reimbursed the claimed amount to the tune of Rs. 1,86,59,150 (One crore eighty six lacs fifty nine thousand one hundred fifty) out of Rs. 4,43,98,450 to the said hospital.
A patient named Paramjeet Kaur village Turna in Jalandhar district was admitted to the hospital for operating gall bladder stone but due to her personal reasons she did not undergo the operation. In this regard, the hospital prepared a fake medical bill of Rs. 22,000 for this patient and took reimbursement claim form IFFCO TOKIO under the Ayushman Bharat health insurance scheme. Furthermore, Uppal disclosed that in another such case patient Sukhjinder Kaur village Sidhupur was admitted to the same hospital for gall bladder operation. She presented her smart health card issued by the Punjab government but the director of this hospital asked the patient that her treatment could not be done with one smart card. In this connection, the hospital director told the patient to either deposit Rs. 25,000 in cash or bring 6/7 smart cards to avail the benefit of treatment. After this Sukhjinder Kaur’s family submitted three smart cards belonging to her family members to the hospital while facing under-compulsion.
It is pertinent to mention here that this health insurance scheme is being run in the state of Punjab under Sarbat Health insurance scheme. According to this scheme, 40% premium share as a financial assistance is being paid by Punjab government and the remaining share 60% is contributed by central government to the IFFCO TOKIO under this scheme. An amount of Rs. 1000 is being paid annually by the government as premium per family to the IFFCO TOKIO. In this regard, the Punjab Government also issues smart health cards to the poor and underprivileged families. Through this smart card if any beneficiary or his family member gets any serious illness, he/she could be admitted to the listed hospitals under this scheme and avail free cashless treatment upto Rs. five lakhs.