AIIMS Patna unearths Ayushman Bharat fraud

Two patients have allegedly defrauded the government of around ₹2 lakh, undergoing surgeries at Patna’s All India Institute of Medical Sciences (AIIMS) free of cost against Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY) cards, which state health officials now claim are fake, an investigation by HT has revealed.

“The two cards are fake. We are trying to locate the agency which issued these cards, and their approvers. We are collecting details. Give us some more time,” Alankrita Pandey, chief executive officer of the Bihar Swasthya Suraksha Samiti (BSSS), said on Thursday evening.

This is the state’s first such reported fraud, among many more suspected, since the launch of the scheme on September 23, 2018, in which alleged ineligible beneficiaries have availed of free treatment against fake PMJAY cards, bypassing the Aadhar-based biometric authentication system, said an official familiar with the matter.

Avinash Kumar, 36, who works in the Buxar Nagar Parishad (the local civic body) and Ashok Kumar Singh, 58, a farmer of Bhojpur, underwent procedures for double valve replacement of the heart and closure of stoma (an opening on the belly to allow stool to pass out of the body and into a stoma bag — also known as colostomy closure), after admission at AIIMS on May 9 and May 15, respectively.

Ashok Singh, who was suffering from cancer, passed away on May 22.

Avinash Kumar is recuperating on bed number 15 of the hospital’s D1B ward.

“My father has developed paralytic stroke post-surgery. We’ve already had to pay around ₹30,000 for post-surgery management after the hospital changed the patient category of my father from PMJAY to general on May 19, saying his card is fake. When around ₹1.84 lakh was sanctioned in two instalments through the card, how can it now be fake? We are poor people, and don’t have money or the resources,” said Kumar’s son Vicky Kumar, 21, who works in Assam.

His father’s name on the ration card, a photo of which Vicky shared with this reporter, did not match with that of his Aadhar. Having a ration card is a prerequisite to be a PMJAY beneficiary.

Singh’s son, Lallu Kumar, 28, refused to share a copy of his father’s ration card, saying he was in mourning.

“What is the point sharing a copy of my father’s ration card or trying to unblock his PMJAY card now when he is no longer alive,” he said.

Kumar and Singh would have gone unnoticed had they not required funds for post-surgery management. This necessitated adding a medicine code in the PMJAY computer application system to their earlier approved surgery code, a process that got stuck and their cards (M6NOLM5PV and M58DI7I7K) were blocked on May 19-20, another official said.

Kumar had to be shifted to the intensive care unit (ICU) after his cardiac surgery on May 10.

Singh required ventilator support after the procedure for closure of stoma. He underwent two procedures on May 17 and May 20. When his condition began to deteriorate and the AIIMS revoked his facility of free treatment under PMJAY, which made his family members pay around ₹3,000 for post-surgery management, they opted for a voluntary discharge and took Singh home, where he passed away on May 22, said his son Lallu.

The Bihar Swasthya Suraksha Samiti (BSSS), which is the nodal health agency of the state government for PMJAY, and liaisons with the National Health Authority (NHA), New Delhi, which manages the implementation of the scheme, had initially approved the admission and treatment of the two patients at AIIMS.

The BSSS had sanctioned ₹2.26 lakh for double valve replacement of Kumar’s heart and another ₹15,950 for closure of stoma in Singh’s case, as per the package rates under the scheme, said an official.

The BSSS has now sought NHA help to extract information on the agency that generated their cards, and their approvers.

There are over 60,000 village level entrepreneurs in Bihar, besides Ayushman mitras in public and private empanelled hospitals, panchayati raj executive assistants, and the UTI Infrastructure Technology and Services Limited (ITSL), an NHA-empanelled agency, among the card creator agencies for PMJAY.

The AIIMS did not respond by Friday to HT’s mail on Tuesday, requesting for a response how the patients bypassed the Aadhar-based biometric authentication system during their admission under PMJAY.

“I have got the mail and (am) working on it,” Dr Gopal Krushna Pal, executive director of AIIMS-Patna, texted on Tuesday in response to HT’s message the same evening. Dr Pal or public relations officer Dr Shreekant Bharti did not respond to HT’s reminder message on Thursday.

AB PMJAY is the Prime Minister’s flagship health scheme and also the world’s largest fully government financed health insurance on 60:40 fund sharing between the Centre and state government, providing a cover up to ₹5 lakh annually for secondary and tertiary hospitalisation to India’s 107.4 million poor and vulnerable families (500 million approx. beneficiaries), based on deprivation and occupational criteria, as per the socio-economic caste census (SECC) database of 2011.

Over 10.8 million such families, covering around 55 million beneficiaries (approx.), are in Bihar.

The state, however, is among the lowest in terms of enrolment percentage under Ayushman Bharat, having issued only 78 lakh cards among its beneficiaries so far. Hindustan Times