Gujarat: Why 7 hospitals faced action under PMJAY within one year

However, this is not the lone lawsuit related to alleged fraud nether PMJAY strategy successful the state. On November 13, Dhananjay Dwivedi, the Principal Secretary of Health, said that successful the past 1 year, SAFU had visited 95 hospitals. Irregularities recovered successful respective of these hospitals had led to penalties amounting to Rs 20 crore being levied connected them. Further, Rs44 lakh illegally charged from 1,024 beneficiaries had been returned to them.

However, of these 95 hospitals and doctors practising there, the authorities had recovered that 7 hospitals and 4 doctors had committed the level of irregularities that deemed suspension from the strategy and the imposition of ample monetary penalties, totalling Rs8.94 crore for nonaccomplishment caused to the authorities exchequer and patients.

The Indian Express takes a look astatine these cases:

1) ‘Unnecessary’ cardiology surgeries

Khyati Hospital, which was de-empanelled and permanently blacklisted from PMJAY-MA connected November 13, picked up patients from a Mehsana colony pursuing a aesculapian campy and performed angioplasty connected 7 of them. It was alleged that the process was unnecessary and carried retired without consent. Bachhu Govaji Barot (77), who was among those who underwent the surgery, said the acquisition traumatised him. “We merit justness and compensation,” helium said. Six people, including the visiting cardiologist who performed the surgeries, person been arrested.

The visiting Cardiologist astatine Khyati Hospital, Dr Prashant Vazirani, was accused of having performed unnecessary angiography and angioplasty surgeries to marque illicit gains from the scheme. He was besides suspended from the strategy connected November 13.

2) ‘Upcoding’ assisted organization deliveries

Naritva Women’s Medical Studio successful Ahmedabad was suspended from the PMJAY connected October 25 and a punishment of Rs 1.22 crore was imposed connected it.

Owned by Turning Point Health Care Pvt Ltd, the installation has 3 premises – successful Bapunagar, New Naroda and Gota – successful Ahmedabad. It is tally by Group CEO Dr Vijay Pandya.

An probe by the State Anti-Fraud Unit (SAFU) of PMJAY-MA strategy showed that the infirmary had carried retired “upcoding” successful the assertion for “Ruptured Uterus and Assisted Vaginal Delivery – Vacuum/ Episiotomy” process connected respective occasions. As portion of upcoding, a healthcare supplier bills for a work oregon process that is much costly oregon terrible than what was really provided.

3) Healthy children presented arsenic sick

Nihit Babycare Children Hospital successful Rajkot is owned and tally by Dr Hiren Mashru, a paediatrician. A tip-off from a whistleblower that led to a probe by the SAFU arsenic good arsenic auditors from the security institution contracted for payouts nether the PMJAY recovered that the infirmary allegedly manipulated pathological laboratory reports of 18 children and uploaded mendacious X-ray reports of 98 children, to guarantee they were admitted to the hospital.

The fraud allegedly went connected for 10 months. The infirmary was suspended connected June 27 and fined Rs 6.54 crore. Dr Mashru, was besides suspended from the strategy connected October 25, for manipulating and forging aesculapian records of newborns.

4) False signatures and stamps

Sunshine Global Hospital, with branches successful Vadodara and Surat, some tally by M/s. Baroda Medicare Private Limited, was suspended from the PMJAY strategy connected October 25. At the Vadodara facility, the SAFU recovered deficiencies successful the Surgical Oncology department, starring to it being suspended from the circumstantial Oncology cluster. The authorities besides imposed a punishment of Rs 10.84 lakh connected the hospital. Further, during an inspection, Surgical Oncologist Dr Mihir Shah was recovered to beryllium engaged successful alleged “upcoding” of surgical packages. He was besides suspended from the scheme. Meanwhile, the sister infirmary located successful Surat was suspended from the Oncology Speciality of PMJAY aft it was recovered that “false signatures and stamps” were made connected the Tumour Board Certificate (TBC). The installation was fined to the tune of Rs 1.06 crore.

5) Infrastructural deficiency

While determination were nary aesculapian oregon fiscal irregularities recovered astatine the Trust-run Everest Hospital successful Una municipality of Gir Somnath district, the infirmary was suspended from PMJAY due to the fact that it did not person a Building Use (BU) support from its section civic body. This infirmary was suspended from each specialities connected June 27. No good was imposed.

6) Overcharging patients

At Shiv Hospital successful Ahmedabad, a flying squad of the SAFU recovered that patients were being charged higher rates than permitted. It was suspended connected June 27 and fined Rs 5,600.

7) Upcoding crab radiation

Dr Ketan Kalariya, a Radiation Oncologist astatine Samanvay Hospitals successful Junagadh, is accused of “upcoding” a radiation bundle assertion of a diligent uploaded connected the PMJAY site. He was suspended from the strategy connected October 25.

When hospitals threatened to suspend services nether scheme

Under the hybrid Ayushman Bharat PMJAY-MA strategy tally by the authorities of Gujarat, the insurer has a liability to wage claims up to Rs 1 lakh portion the remaining is paid from a authorities authorities trust.

However, betwixt August 2023 and February 2024, determination was immoderate hostility betwixt backstage hospitals empanelled nether the strategy and the authorities authorities implicit dues to the tune of Rs 650 crore owed by the authorities to the hospitals for treating patients nether the scheme.

After respective months of negotiations with authorities wellness curate Rushikesh Patel assuring action, the substance was yet sorted retired earlier this twelvemonth with the involution of the past Union Health Minister Mansukh Mandaviya.

Dr Bharat Gadhvi, Convener of the Gujarat Association of Hospitals and Nursing Homes and Allied Healthcare Services, told The Indian Express, “There were respective issues with the payments pending to hospitals…However, they were sorted retired to a ample grade earlier this twelvemonth with assistance from ministers Mandaviya and Patel…The process for payments to the hospitals was besides amended astatine that clip to everyone’s satisfaction.”