RGHS CT, MRI and Colour Doppler Claims Fall 35.4% After Tighter Approval Rules in Rajasthan

Diagnostic claims under Rajasthan Government Health Scheme decline sharply after restrictions on multiple scans and mandatory pre-authorisation for clinically necessary repeat investigations

The Rajasthan Government Health Scheme (RGHS) has recorded a significant decline in high-cost diagnostic claims after tightening approval rules for CT, MRI and colour Doppler scans. According to data from the Rajasthan State Health Assurance Agency (RSHA), claims for these investigations fell by 35.4% between April and July 2026 compared with the corresponding period last year.

The number of claims declined to 61,755 during April-July 2026 from 95,659 in the same period last year, a reduction of 33,904 claims. The total claimed amount also dropped by 49.2%, from Rs 23.7 crore to Rs 12 crore.

Revised RGHS Rules Restrict Multiple Diagnostic Scans

The decline followed an RSHA order issued on March 30, 2026, which was implemented from April 1. Under the revised guidelines, more than one MRI, CT scan or colour Doppler investigation cannot ordinarily be booked for a single OPD patient under RGHS.

If multiple investigations are considered clinically necessary, empanelled hospitals, diagnostic centres and imaging centres are required to obtain pre-authorisation from the Third Party Administrator (TPA).

The TPA is required to approve, reject or raise a query within three hours of receiving the request.

Focus on Preventing Unnecessary Investigations

RGHS Project Director Dr Nidhi Patel said the scheme is intended to ensure that eligible beneficiaries receive quality medical care whenever required rather than promote unnecessary investigations.

She said technology-based monitoring, data analysis and pre-authorisation checks are being strengthened to prevent misuse and ensure transparent utilisation of public funds.

Inquiry Reports Flagged Alleged Misuse

The stricter controls were introduced after inquiry reports flagged alleged misuse of diagnostic facilities under the scheme.

Officials found instances where CT scans with and without contrast were conducted without adequate medical necessity. Such practices were reported to have increased financial pressure on RGHS while also exposing patients to avoidable radiation.

Investigations also identified cases in which whole-body MRI scans were allegedly prescribed without a clear chief complaint or valid clinical justification.

Following the findings, two laboratories and several doctors were suspended.

Important Highlights

• RGHS diagnostic claims for CT, MRI and colour Doppler scans fell by 35.4% between April and July 2026.
• Claims declined from 95,659 to 61,755 during the corresponding period.
• The total claimed amount fell 49.2%, from Rs 23.7 crore to Rs 12 crore.
• Revised rules restrict booking more than one CT, MRI or colour Doppler investigation for a single OPD patient without pre-authorisation.
• Inquiry reports flagged alleged unnecessary diagnostic investigations and possible misuse of scheme facilities.
• Two laboratories and several doctors were suspended following the findings.