CAG uncovers massive fraud within Ayushman Bharat scheme
NEW DELHI: The CAG identified a significant fraud within the Ayushman Bharat scheme (Pradhan Mantri Jan Arogya Yojana) of the central government. This scheme offers medical insurance of five lakh rupees per year to low-income individuals, including those in Kerala. The report presented in Parliament also suggests that both national and state health authorities investigate the irregularities.
The CAG pointed out a serious error in the beneficiary database. Numerous names are fictitious, dates of birth are inaccurate and invalid identification cards were utilized. There were also instances of fraud involving Aadhaar numbers and mobile numbers, which serve as the foundation for the 9-digit ID required to avail the benefits. In Tamil Nadu, 4761 registrations were completed using seven Aadhaar numbers.
There were cases where benefits were claimed on behalf of deceased individuals amounting to a fraudulent sum of 6.97 crores. These claims encompassed 3,903 cases involving 3,446 patients who had passed away. Among the states, Kerala reported the highest number of such frauds (966 cases) leading to hospitals receiving Rs 2.60 crore inappropriately.
Various audits including Medical Audit, Death Accounts Audit, Beneficiary Audit, Pre-authorization Audit and Claim Audit were not conducted in Kerala. Additionally, Kerala stood out for admitting a single patient to multiple hospitals during the same period. This particular form of fraud affected 7011 patients in 9632 cases. Following Kerala, states such as Madhya Pradesh (403 cases), Chhattisgarh (365 cases) and Jharkhand (250 cases) reported a higher number of frauds involving deceased individuals.
The report also highlighted instances where 7,49,820 beneficiaries provided incorrect mobile numbers, such as 9999999999 across the country. Similarly, 1.39 lakh people registered with the mobile number 8888888888 while 9 lakh individuals shared the mobile number 3. This scam revolves around mobile phone numbers which are a crucial tool for beneficiary identification.
The scheme has attracted participation from over ten crore individuals across the nation. It covers medical treatment in both government and private hospitals that are part of the scheme.