Hospital slapped Rs 6.54 Crore fine for Tampering with Medical Reports, Inflating Bills under PMJAY Scheme

Rajkot: A major scam in the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme recently came to light in Rajkot, where a paediatric hospital has been fined Rs 6.54 crore for committing irregularities under the scheme in the case of 116 patients.

According to a TOI report, the hospital allegedly tampered with medical reports and submitted inflated bills to the Health Department for its approval. The irregularities came to light during the investigation conducted by the Health Department.

The Health Department probe for over 45 days uncovered the irregularities conducted by the doctor, who runs the hospital located on Laxmi Nagar Main Road.

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As per the latest media report by the Times of India, the District Health Authority has informed that for these 116 patients, modified reports were sent for approval with a total claim amount of Rs 65.47 lakh. 

The District Health team started to probe the issue after detecting the anomalies. Standard Procedures require the doctors to send the lab reports and x-rays to justify the diagnosis of the patient. Under the PMJAY scheme, a patient can get up to Rs 10 lakh worth free treatment, with different packages for different types of diseases.

However, as per the officials, the doctor at the hospital admitted the children to the NICU for an extended period by tampering with the lab reports. This was done by the hospital to garner more funds.

To verify the records of 524 children, the Health Department team visited the laboratories, gathered the test reports and matched the same with the reports that the hospital had submitted for claims. Allegedly, the reports were manipulated on the computers at the hospital.

Taking note of these irregularities, the Health Department issued a penalty notice on Friday and asked the hospital to pay a fine of Rs 6.54 crore, ten times the claim amount of Rs 65.47 lakh.

Apart from this, the hospital has also been debarred from the PMJAY scheme and is also facing de-registration. Strict action might also be taken against the doctor, who may lose his licence to practise.

Commenting on the matter, the in-charge chief district health officer, Dr. P K Singh told TOI, "The hospital tampered with the lab reports and x-ray reports. A committee in Gandhinagar approves the package based on these reports. The hospital had admitted 524 children since July last year. We found evidence of irregularities in the case of 116 children during our investigation."

Medical Dialogues had last month reported that taking action against the paedistrician involved who was accused of manipulating the reports of the newborns to extract a huge sum of money from the Government's Ayushman Bharat Scheme, the State Health Department has expelled him from the Ayushman Card scheme of health insurance. The doctor running the hospital was accused of having admitted perfectly healthy children to the Intensive Care Unit (ICU) to fraudulently obtain funds from the Ayushman scheme.

Also Read: Ayushman Bharat Fraud: Rajkot Paediatrician expelled for manipulating reports, extracting Rs 2.53 crore