A total of Rs 6.97 crore was paid under the Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana for the treatment of 3,446 patients who had previously been declared dead, the Comptroller and Auditor General of India has flagged, The Indian Express reported on Wednesday.
Launched in 2018, the Pradhan Mantri Jan Arogya Yojana, or PMJAY, is the Central government’s flagship scheme for health insurance for poor people. It offers health insurance coverage of up to Rs 5 lakh to families.
In the performance audit, the Comptroller and Auditor General noted that patients earlier shown as “died” in the Transaction Management System of the scheme continued to get treatment under the scheme.
The auditor added that it found 3,903 such claims, pertaining to 3,446 patients, according to The Indian Express.
It said that the most number of ‘dead’ patients – 966 – were found in Kerala, where Rs 2.60 crore was paid for their treatment. This was followed by Madhya Pradesh where 403 such patients for whom Rs 1.12 crore was paid and Chhattisgarh where Rs 33.70 lakh was paid for 365 patients.
As per rules, if a patient dies after getting admitted to a hospital and before discharge, payment to the hospital is done following an audit, reported The Indian Express.
In its report, the Comptroller and Auditor General said that it had flagged the flaw regarding the registration of dead patients to the National Health Authority first in 2020.
“NHA [National Health Authority] while acknowledging the audit comment, stated in July 2020 that necessary check[s] have been put in place on 22 April 2020 to ensure that PMJAY ID of any patient who has been shown as died in TMS [Transaction Management System] is disabled for availing further benefit under the scheme,” the report said.
The Comptroller and Auditor General also said that despite claims of corrective measures being put in place, the system allowed for patients previously marked as dead to continue receiving treatment under the scheme, according to CNBC TV18.
It added that in August 2022, the National Health Authority said that “back-date of admission is allowed” in the system for “various operational reasons”, reported The Indian Express.
Last week, the Comptroller and Auditor General had also flagged that nearly 7.5 lakh beneficiaries under the PMJAY are registered under a single cellphone number – 9999999999.