Operation Modicare: Some Hospitals Don’t Care About Modicare, Refuse To Treat Patients

Ayushman Bharat — also known as Modicare — seems to have been contaminated by infectious greed, with some hospitals on its panel refusing treatment to patients entitled to the scheme, an India Today investigation has found.

Billed as a game-changer for the most vulnerable, Ayushman Bharat was launched by Prime Minister Narendra Modi in September last year, targeting 50 crore beneficiaries.

GAME-CHANGER IN HEALTHCARE

India Today’s Special Investigation Team (SIT) found that the project could be running up against non-compliance in terms of its implementation on the ground.

So far, around 16,000 hospital have been empanelled for the programme. But, the probe discovered some of them shying away from treating the patients entitled to Ayushman Bharat scheme.

Of the target 50-crore beneficiaries, more than 40 lakh have already been enrolled in the PM Modi’s flagship healthcare project.

The cashless and paperless scheme promises an annual cover of Rs 5 lakh per family, with no cap on family size. The assurance covers surgery, daycare, medicine, diagnostics and transport costs.

EMPANELLED HOSPITALS REFUSE MODICARE

But when India Today’s reporters, posing as attendants of a poor typhoid patient, visited the Golden Hospital in Haryana’s Palwal district, it refused treatment.

The healthcare facility is listed on Ayushman’s panel as reflected on the project’s online portal.

Dr Anshuman Das, the Golden Hospital’s medical head, claimed that typhoid was not covered under Ayushman Bharat scheme.

“Are you empanelled on Ayushman Bharat?” asked the reporter.

“Yes.” Das replied.

“We’d like to have our housemaid hospitalised. She’s suffering from typhoid,” the journalist said.

“Typhoid is not covered. Typhoid is not listed. Nor is malaria, dengue, chikungunya, enteric [typhoid],” the doctor said.

But he was not giving the full picture.

MODICARE PORTAL SAYS IT ALL

The website of Ayushman Bharat is a one-stop source for all information linked to the programe – from the comprehensive list of empanelled hospitals in every state to conditions they cover.

Against their names, the designated facilities have specific codes assigned for treatments they are required to offer to the beneficiaries.

Down below, the codes are explained for specialities covered – M1 for general medicine and M6 for radiation oncology, for instance.

Another webpage on the portal takes us to a wider list of specialities. When clicked, a Microsoft Excel document opens up, showing conditions and diseases assured under the programme.

DOCTOR: INDIANS WANT FREEBIES

When India Today’s team looked up the portal, the search revealed that the Golden Hospital is required to treat enteric fever, a medical term for typhoid, under Ayushman Bharat packages.

But its medical head scorned the scheme as a wasteful freebie.

“The biggest problem our country faces is that people even queue up for poison if it’s supplied for free. Would your maid not get treated had there been no Ayushman Bharat?”the doctor argued.

At a government hospital in Haryana’s Palwal, India Today’s investigative team next met Jitendra, the district information manager for Ayushman Bharat.

But he too refused hospitalisation under the scheme.

“I will not be able to admit [the patient] under Ayushman here. I can only refer her [elsewhere] after issuing medicines,” he claimed.

AYUSHMAN OFFICIAL ALLEGES REIMBURSEMENT ISSUES

Jitendra rather sought to justify the Golden Hospital’s refusal to treat Ayushman Bharat patients, saying the facility had not been reimbursed in previous cases.

“Here’s the problem,” he alleged. “In your case, for example, they [Golden Hospital] would be spending more than Rs 1,800 on the patient, which will be more than it could save. The hospital has yet to receive pending dues in the range of Rs 10,800, Rs 14,400 and Rs 16,200. How can one ignore these dues? Patients have already been discharged.”

India Today’s SIT next moved to Uttar Pradesh.

In the state’s Bulandshahr district’s Rana Hospital, the undercover reporters met Jitendra, the man in charge of Ayushman Bharat at the same facility.

“Do you admit patients under Ayushman here?” the reporter asked.

“We do,” replied Jitendra.

But when he heard of a typhoid patient, he refused admission under the PM’s flagship healthcare scheme.

“Typhoid? We have 1,400 codes under Ayushman, but they don’t include this [typhoid]. This code is only available with government hospitals,” Jitendra said.

“The patient is serious,” the undercover reporter said.

“We could have treated if it was permitted under the assigned codes. You can show the patient in OPD. But that’s payable,” he said.

When India Today checked Ayushman Bharat’s portal again, the Rana Hospital in Bulandshahr is found to be under obligation to treat typhoid under the general medicine category.

A similar refusal met India Today’s SIT at Ghaziabad’s Shivam Hospital and Heart Centre, another facility on the Ayushman Bharat panel, when the investigative reporters inquired about admission of a bronchitis patient.

Its doctor, Mukesh Sharma, suggested another hospital for treatment.

Bronchitis, the SIT found, is covered under Ayushman Bharat on its portal.

“My housemaid is diagnosed with bronchitis. She needs hospitalisation under Ayushman,”the undercover reporter said.

“This is not listed on our panel. You take her either to Mohan Nagar or to the xxx hospital. We have general medicine, orthopaedic and gynaecology. Four conditions in total are covered. We don’t treat lung ailments,” he claimed, contrary to what’s stated on the Ayushman Bharat portal.

AYUSHMAN CHIEF VOWS ACTION

When contacted, the Ayushman Bharat CEO, Dr Indu Bhushan, encouraged patients to file complaints if refused treatment at empanelled hospitals. – India Today

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