Raipur/Durg: A major crackdown by the Chhattisgarh government has revealed large-scale fraud under the Centre’s flagship Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY), with over 20 private hospitals penalised for fabricating claims, admitting ghost patients, and running without basic infrastructure.
In a field inspection conducted on 31 January, a team from the state nodal agency found Raipur-based Shri Shyam Hospital operating without a single doctor on duty. The hospital, despite claiming to have three specialists, could not produce any proof. It also admitted critical patients despite having no Intensive Care Unit (ICU), the inspection report noted.
Shri Shyam Hospital was among 23 private hospitals facing action in what officials described as the state’s first large-scale crackdown on PMJAY misuse. While some facilities have been de-empanelled for up to a year, others face suspensions ranging from three to six months.
The field investigations were launched following alerts from the National Anti-Fraud Unit under the National Health Authority (NHA), which flagged suspicious hospitalisations and billing patterns in 28 private hospitals across the state.
Chhattisgarh has nearly 584 hospitals empanelled under AB-PMJAY, a majority of which are small facilities with less than 20 beds. These hospitals, especially in underdeveloped districts, handle a large chunk of patient load under the scheme, but many were found to lack basic standards.
“Most patients are getting treated for minor procedures because the infrastructure to support anything more is absent,” a senior official from the state health department said.
Even major private hospitals were found complicit in irregularities. Raipur’s Ramakrishna Care Hospital, SMC Heart Hospital, and Agarwal Hospital, along with Hi-Tech and Sparsh hospitals in Durg, were penalised for dual billing and ‘upcoding’—a practice of charging for more expensive procedures than were performed.
AB-PMJAY offers free hospitalisation of up to ₹5 lakh annually to over 55 crore Indians. In Chhattisgarh, nearly 90 percent of the 3.25 crore population is covered. The state also funds up to ₹50,000 in treatment for people outside the central eligibility list.
Public health experts blame lax monitoring and weak entry barriers for the widespread abuse. “In my experience, Chhattisgarh lacked proper checks on empanelled hospitals,” said a former official of the now-disbanded Chhattisgarh State Health Resource Centre.
Officials admit the situation is worrying. “We have not been regularly reviewing empanelled hospitals. That will change now,” said Amit Kataria, Secretary of Health and Family Welfare, Chhattisgarh. He said the state is now working on a stricter compliance and audit mechanism.
Health Minister Shyam Bihari Jaiswal defended the inclusion of small hospitals, especially in remote areas, citing the need for accessible healthcare. “We know there are issues, but removing small facilities would leave these areas with no medical access,” he said.
Experts warn that systemic reforms are needed. “Punishment alone isn’t enough. A concurrent system of quality checks and standardisation is essential,” said public health expert Raman V.R.
Private hospital associations, meanwhile, argue that low government-fixed package rates under the scheme drive many providers away and create conditions for fraud. “The rates are 20–30 percent lower than those under CGHS. That has discouraged big hospitals,” said Ameera Shah, president of NAThealth, a private healthcare network.
The state government, however, says the shift of PMJAY funds from private to public hospitals—from 80:20 earlier to 60:40 now—has helped improve accountability and use of resources.
