Fresh expert panel to review alleged Ayushman Bharat scheme irregularities at GMC Anantnag

Srinagar: A fresh high-level inquiry has been ordered by the Jammu and Kashmir government into allegations of irregularities in cardiology procedures performed under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)–SEHAT scheme at Government Medical College (GMC), Anantnag. 

The government has constituted a four-member expert committee to review the findings of an earlier inquiry, examine the written defence submitted by the suspended cardiologist and submit its report within 15 days.   

Also Read:GMC Anantnag cardiologist suspended over alleged PMJAY claim irregularities

The committee will be headed by Prof. (Dr.) Khalid Mohi-ud-Din, professor at GMC Srinagar. Its other members include Prof. (Dr.) Dharminder Kumar and Prof. (Dr.) Sanjeev Bhat, both professors at GMC Jammu, along with Dr. Misbah Samad, State Nodal Officer of the State Health Agency (SHA), Jammu and Kashmir.

According to the government order, the panel will examine the recommendations of the previous expert committee, scrutinise the accused cardiologist’s written defence and supplementary submissions, and review relevant medical records related to the procedures performed. 

“It will also verify package selection details, assess the appropriateness of procedures performed, examine pacemaker implantation records, procurement and billing documents, and evaluate the financial implications arising from claims raised under the AB PM-JAY/SEHAT scheme,” the order said, reports Greater Kashmir.

The committee will also determine whether the procedures complied with national clinical guidelines and PM-JAY package norms before submitting its findings and recommendations. The State Health Agency and GMC Anantnag have been directed to provide all necessary records, documents, technical inputs and logistical support to the panel.

The matter came to light after complaints were received by the State Anti-Fraud Unit alleging that some beneficiaries under the supposedly cashless AB PM-JAY/SEHAT scheme had incurred out-of-pocket expenses for treatment.

A subsequent audit reportedly detected unusual patterns in claims related to advanced cardiac procedures. The SHA then referred the matter to an expert panel of cardiologists from the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, for technical evaluation. 

Based on the audit findings and the expert panel’s observations, the government issued a charge memorandum against the doctor.

Medical Dialogues had previously reported that a senior cardiologist at Government Medical College (GMC), Anantnag, has been suspended by the Jammu and Kashmir government following allegations of irregularities in the reporting of cardiac procedures under the Pradhan Mantri Jan Arogya Yojana (PMJAY).

The allegations against him include submission of claims under incorrect package codes, performance of invasive procedures without adequate clinical indication, violation of procurement norms, and instances where beneficiaries allegedly had to bear expenses despite scheme coverage. 

The inquiry alleged that 101 Left Bundle Branch Area Pacing (LBBAP) procedures were billed as dual-chamber pacemaker implantations under the PM-JAY/SEHAT scheme. It further cited a technical assessment that reportedly found 27 out of 55 reviewed patients had normal ventricular function, suggesting that the procedures may not have been clinically required.

However, the earlier assessment later faced questions after senior SKIMS officials clarified that the institute had no institutional role in preparing the report and that opinions were obtained from some cardiologists who had retired.

The suspended cardiologist has denied the allegations, maintaining that the procedures performed were clinically justified. In his written defence submitted to the government, he reportedly challenged the findings of the earlier inquiry, which will now be examined by the newly constituted committee.

Also Read:JnK hospitals threaten suspension of Ayushman Bharat services over Rs 295 crore dues