Reacting to a report that claimed a family in Gujarat had obtained 1700 Ayushman Card through fraud, the National Health Authority (NHA) has said that the matter was detected by National Anti-Fraud Unit (NAFU) in August 2019 and shared with the Gujarat Health agency which disabled the cards. An FIR was lodged by the State on November 8, 2019. An NHA official told FE Online that the health authority has been proactively detecting suspect e-cards with the help of algorithms developed by NAFU. The detected frauds are shared with states for due diligence and action. The media report on the fraud in Gujarat was based on the same information shared by NAFU with the state.
No ‘farzi’ e-card possible
The official said that there is no possibility of a ‘Farzi’ (fake) e-Card being generated automatically by the System. Explaining the reason, he said: “The e-card generation process requires a go-ahead by the authorised persons based on supporting documents and final approval of the State Health Agency officials to not just create an e-Card, but also to add any additional family members.”
171 hospitals banned
So far, 171 hospitals have been already de-empanelled and the list of these hospitals is posted on PMJAY website. Also, penalties to the tune of over Rs 4.5 crore have also been levied on hospitals indulging in malpractices.
The Ayushman Bharat-PMJAY scheme provides a cover of Rs 5 lakh per family and not per e-Card.
The NHA official said that the responsibility for closure action against fraudulent entities and fake cards lies with State Health agencies which carry out their due diligence before action.
NHA said that suspicious cases being triggered by NAFU forensics team are regularly shared with the States for conducting medical audits. Number of triggered transactions shared with States so far amount to 0.25% of total admissions out of which 0.07% of total admissions have been confirmed as fraud so far, As many as 0.58% cases of suspect ecards have been sent to the States for investigation.
As per details provided by the States, over 390 hospitals have been served Show Cause Notice/suspended/de-empanelled in different states. Out of which 171 hospitals have been de-empanelled. FIR has also been lodged against six hospitals in Uttarakhand and Jharkhand. Amount of penalties levied on such hospitals is over 4.5 crore in nine states.
The official said than NHA keeps a close watch on wrongful enrolment of beneficiary and 3,785 Village Level Entrepreneurs (positioned at Common Service Centres) / Pradhan Mantri Arogya Mitras (positioned at PMJAY empanelled hospital) have been deactivated so far.