Multi-crore fraud in Rajasthan health scheme: Doctor, lab operator arrested
Jaipur: A multi-crore fraud has been uncovered in the Rajasthan Government Health Scheme (RGHS), in which a doctor and a private lab operator allegedly colluded to create fake prescriptions and diagnostic reports to claim reimbursements from the state government. Two accused have been arrested in connection with the case.
The Special Operations Group (SOG) of the Rajasthan police has unearthed a major fraud in the Rajasthan Government Health Scheme, involving doctors and a lab operator allegedly causing financial losses worth crores to the state exchequer, police said.
The alleged irregularities came to light during a probe into the implementation of the RGHS, a flagship scheme aimed at providing free and accessible healthcare services to the general public and government employees, said Vishal Bansal, Additional Director General of Police (SOG).
According to officials, the fraud was carried out through a nexus between certain doctors and laboratory operators, who allegedly generated fake prescriptions and diagnostic reports to claim reimbursements from the state government.
Two accused, an associate professor (Orthopaedics) posted at SK Hospital in Sikar and an operator of a private lab in Sikar, have been arrested in connection with the case, police said, reports PTI.
Police said the accused doctors allegedly prescribed unnecessary diagnostic tests, including expensive MRI scans, without examining patients or even in their absence. Fake reports were then prepared and uploaded to the RGHS portal to claim payments.
In some instances, normal MRI tests were falsely billed as “contrast MRI” to inflate claims, while in others, multiple reports were generated for a single test to raise additional claims, officials said.
Investigations also revealed that prescriptions were issued on days when the concerned doctors were not present, and report dates were manipulated to process fraudulent claims.
In one instance, an MRI report dated December 4, 2023, was altered to December 5 to secure reimbursement, even though the patient had not visited Sikar on that day. In another instance, claims were raised in the name of a patient admitted to a different hospital.
Officials further said that in several cases, referrals from private doctors were altered as issued by government doctors to make them eligible under the RGHS.
Following a formal complaint filed by the health department, a case has been registered, and an investigation has been launched, police said.
“The fraudulent practices have not only caused significant financial losses to the state but have also affected genuine beneficiaries and undermined the credibility of the scheme,” Bansal said, according to PTI.
Further investigation is underway to identify the involvement of other doctors and lab staff, and strict legal action will be taken against all those found guilty, police added.
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