Union Health Minister Details Action Against Fraudulent Hospitals in Lok Sabha
New Delhi: Union Health Minister Shri Prataprao Jadhav informed the Lok Sabha that 1,114 hospitals have been de-empanelled, 1,504 hospitals penalised Rs 122 crore, and 549 hospitals suspended for fraudulent activities under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
Hospitals Cannot Deny Treatment to Eligible Beneficiaries
The Minister clarified that empanelled hospitals are obligated to provide treatment to eligible beneficiaries under the scheme. Beneficiaries facing denial of treatment can lodge grievances through a three-tier redressal system established at district, state, and national levels.
Robust Anti-Fraud Measures and National Anti-Fraud Unit
Jadhav highlighted the zero-tolerance policy towards misuse under AB-PMJAY and the establishment of the National Anti-Fraud Unit (NAFU) responsible for prevention, detection, and deterrence of fraudulent activities across the scheme.
Grievance Redressal and Claims Settlement Mechanism
The Minister detailed that beneficiaries can file complaints via multiple channels including a web portal (CGRMS), call centers, email, and letters to State Health Agencies. Claim settlements are overseen by State Health Agencies, with timelines of 15 days for intra-state claims and 30 days for portability claims. Continuous improvements in turnaround times have been reported.
Response to Parliamentary Questions on Scheme Misuse and Patient Safety
Shri Prataprao Jadhav responded to queries about rising fraudulent transactions, recovery of funds, denial of treatment by private hospitals, and deaths due to unnecessary surgeries. He assured suitable actions have been taken and emphasised the scheme’s commitment to beneficiary protection and timely claim payments.
