203 Andhra Pradesh hospitals fined Rs 34.39 crore over NTR Vaidya Seva irregularities

Amaravati: More than 200 hospitals in Andhra Pradesh have faced penalties or disciplinary action over alleged irregularities under the Dr NTR Vaidya Seva scheme in the past two years, including charging beneficiaries for treatments meant to be provided free of cost. 

According to the state Health, Medical and Family Welfare Department, the NTR Vaidya Seva Trust imposed fines totalling Rs 34.39 crore on 203 empanelled hospitals and initiated disciplinary proceedings against 44 healthcare facilities.

The action included suspension of 25 hospitals, stoppage of payments to 13 hospitals, removal of five facilities from the scheme’s network and cancellation of recognition for one hospital, according to an HT report.

The alleged irregularities came to light through complaints that hospitals were denying cashless treatment to eligible beneficiaries, delaying care, violating prescribed medical protocols and failing to provide appropriate patient care. Some facilities were also found to have charged beneficiaries for treatments covered under the scheme.

The Trust investigated the complaints and initiated action against hospitals found to have violated the scheme’s requirements. A report detailing the enforcement measures was submitted to the state health minister by the Trust’s chief executive officer.

To strengthen oversight, officials examine hospital bills and pre-authorisation requests to identify unusual billing patterns, excessive use of treatment packages and suspicious transactions. The process is also designed to detect duplicate claims, alterations in medical records and possible misuse of the scheme. 

The Trust has additionally introduced artificial intelligence (AI)-based systems to speed up bill verification, standardise audits and help clear pending payments.

However, an AI-generated alert does not automatically establish fraud. Bills flagged as suspicious are subject to further scrutiny, with district and state-level officials examining medical records and conducting investigations before deciding whether disciplinary action is warranted, reports Hindustan Times. 

The measures are intended to improve monitoring of empanelled hospitals and help ensure that eligible beneficiaries receive treatment without being charged for services covered under the government scheme.