Five years since it was launched, the government’s health insurance scheme for the poor has come under a cloud. Some of the volunteers engaged in assisting poor patients to get access to free secondary and tertiary care at private hospitals are set to be sacked for allegedly being hand in glove with the medical establishments. The state government has removed nine hospitals from Kolhapur and Sangli cities from the panel of the Mahatma Jyotiba Phule Jan Arogya Yojana, the state government’s health insurance scheme for poor. Eleven other medical establishments have been suspended from undertaking any surgical procedure under the scheme. A state-level monitoring team carried out raids at over 50 hospitals in these two cities over the last four days. The names of the hospitals have been published on the government website.
A health department official associated with the scheme, requesting anonymity, said they had suspended 11 hospitals from Kolhapur city. The suspension is the first stage before the hospitals are removed from the panel. “Once suspended, the hospital cannot admit new patients or beneficiaries under the scheme. In case of de-empanelment, the hospital will be permanently debarred from offering the scheme. We have found that the rules of the agreement were not followed, treatment charges were taken from patients, while in some instances, false cases were made to claim reimbursement,” the official said. A district coordinator of the MJPJAY, requesting anonymity, said that they have decided to sack a few arogya mitra, who were the coordinators at the hospital level. “Also, we are shifting patients admitted in the hospitals, which are facing de-empanelment. The patients are shifted to the other private hospitals empaneled in the scheme,” the coordinator said.
The officials claimed that scrutiny of some other hospitals was still going on and if they are found to have flouted the rules, then they too are likely to face de-empanelment. There were 33 private hospital and one government-run hospital from the district on the panel of the scheme. Now, only 18 hospitals remain. “The arogya mitra is supposed to help poor patients get the benefit of the scheme and ensure that they are not charged by the hospital. We are going to fire some more among them,” said the coordinator. – TOI