PMJAY Fraud: Khyati Hospital misused emergency tags for Rapid Medical Approvals

Ahmedabad: Ahmedabad-based Khyati Multispeciality Hospital is under scrutiny after two PM-JAY beneficiaries died following a failed angioplasty procedure. The hospital allegedly exploited the Pradhan Mantri Jan Arogya Yojana PMJAY scheme by classifying every patient file as an emergency case, thereby fast-tracking approvals for medical procedures under the scheme.

The Crime Branch, which is investigating the case, found that the hospital exploited the PM-JAY scheme to accelerate approvals for medical procedures without properly assessing patients' conditions. By categorizing patients as "emergency" cases, the hospital fast-tracked government approvals and subsequently claimed payments under the Central scheme.

Also read- PMJAY Fraud: Crime branch seeks Patient Records from 145 hospitals

What emerged as a shock was that the hospital used emergency tags on even patients who did not need any medical procedure, which exposed the dark side of its healthcare practices.

In addition, the hospital allegedly bribed a few PM-JAY officers responsible for sanctioning the files which marked every patient as an emergency case. The hospital authorities knew that PM-JAY officials sanctioned between 1,300 to 4,000 emergency applications every day and therefore they exploited the process by bribing the officers.

This was revealed after the crime branch interrogated a few PM-JAY officers who admitted to the wrongdoing. According to crime branch sources, PM-JAY officials indicated that they did not take time to review each application thoroughly and relied solely on the "emergency" tag to expedite pre-authorisation requests so the hospital could proceed with the medical procedures without delay.

Speaking to TOI, a crime branch officer said, "The crime branch has already questioned a few PM-JAY officers suspected to be involved in sanctioning the claims filed by Khyati Hospital. The hospital wanted to avoid scrutiny from unfamiliar PM-JAY officers, so the hospital authorities offered bribes and marked their files as 'emergency' to bypass the review process. This made sure they received approvals without any delay."

Medical dialogues had earlier reported that according to the Ahmedabad crime branch, as many as 112 deaths have occurred in the past three years, either during or after treatment under government healthcare schemes. The revelation came during investigations days after the Ahmedabad crime branch arrested Dr Sanjay Patolia, a bariatric surgeon and one of the directors of city-based Khyati Multispeciality Hospital.

Between September 2021 and October 2024, nearly 8,500 patients received treatment or underwent different surgeries at the private hospital.

Meanwhile, the state health department has proposed to increase the staff from 60 to 180 personnel to handle the approval of medical reimbursement bills from hospitals. They will also demand detailed medical documents, such as angiography and angioplasty reports for heart-related procedures.

Recently, the crime branch arrested another director of the facility bringing the total number of arrests to eight.