RGHS diagnostic claims fall 35 per cent after tighter CT, MRI approval rules
Stricter approval rules under RGHS have reduced CT, MRI and colour Doppler claims by 35.4 percent between April and July 2026, RSHA data shows.
Jaipur: Rajasthan Government Health Scheme (RGHS) has recorded a significant decline in high-cost diagnostic claims after tightening approval rules for CT, MRI and colour Doppler scans. Claims for these investigations dropped 35.4% between April and July 2026, according to data from the Rajasthan State Health Assurance Agency (RSHA).
The number of claims dropped to 61,755 during April-July 2026 from 95,659 in the corresponding period last year, marking a reduction of 33,904 claims. The total claimed amount also fell by 49.2%, from Rs 23.7 crore to Rs 12 crore.
The reduction follows an RSHA order issued on March 30, 2026, and implemented from April 1. Under the revised guidelines, more than one MRI, CT scan or colour Doppler investigation cannot ordinarily be booked for a single OPD patient under RGHS.
If multiple scans are considered clinically necessary, empanelled hospitals, diagnostic centres and imaging centres must obtain pre-authorisation from the Third Party Administrator (TPA). The TPA is required to approve, reject or raise a query within three hours of receiving the request, reports The Times of India.
RGHS Project Director Dr Nidhi Patel said the scheme is intended to ensure that eligible beneficiaries receive quality medical care when required and not to promote unnecessary investigations. She said technology-based monitoring, data analysis and pre-authorisation checks are being strengthened to prevent misuse and ensure transparent use of public funds.
The stricter controls were introduced following inquiry reports that flagged alleged misuse of diagnostic facilities. Officials found instances where CT scans with and without contrast were conducted without adequate medical necessity. Such practices were reported to have increased financial pressure on the scheme while also exposing patients to avoidable radiation.
Investigations also identified cases where whole-body MRI scans were allegedly prescribed without a clear chief complaint or valid clinical justification. Following the findings, two laboratories and several doctors were suspended.
Also Read:RGHS Irregularities: 51 hospitals suspended, Rs 3 crore penalty on 24 facilities
