To curb frauds in the Ayushman Bharat scheme, the National Health Authority (NHA) has taken action against more than 390 hospitals.
These hospitals have been served show cause notice, suspended and de-empanelled in different states.
Out of this, 171 hospitals have been de-empanelled and FIR has been lodged against six hospitals in Uttarakhand and Jharkhand. The ammount of penalties levied is more than Rs 4.6 crores in 9 states, the NHA said.
A close watch is also maintained on wrongful enrolment of beneficiary and 3,785 Village Level Entrepreneurs positioned at Common Service Centres and Pradhan Mantri Arogya Mitras (positioned at PMJAY empanelled hospital) have been deactivated so far.
Suspicious cases being triggered by NAFU forensics team are regularly shared with the states for conducting medical audits. Number of triggered transactions shared with states so far amount to 0.25 per cent of total admissions out of which 0.07 per cent of total admissions have been confirmed as fraud so far. 0.58 per cent cases of suspect ecards have been sent to the States for investigation.
The NHA said that there are certain packages, especially abuse prone packages, which are reserved for government hospitals by the state authorities.
It was detected that private hospitals were performing these government reserved procedures and blocking/submitting the same under a different package name or as unspecified package. These were proactively detected by the system and further action was taken.
In Gujarat, the cases were detected by NAFU in August 2019 and shared with Gujarat State Health agency which has disabled the cards and an FIR was also lodged by the state. Similar instances have taken place in Chhatisgarh, Madhya Pradesh,and Punjab.