Ayushman Bharat scam: Beneficiaries paid money for treatment, claims CAG report

Unearthing corruption in the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) – one of the most ambitious social welfare schemes launched by the Modi government, the Comptroller and Auditor General of India (CAG) had said that beneficiaries paid money for treatment despite the scheme intending to provide cashless services.

In its performance audit report on PMJAY that was tabled during the Monsoon session of Parliament, the CAG said, “After admission of a patient in hospital, expenditure for all diagnostic tests, medicines, implants, etc is to be borne by the hospital since the costs for the same have been included in the cumulative package amount. However, audit noticed instances where patients had to pay as part of their treatment under the PMJAY.”

Rolled out in 2018, the AB-PMJAY provides a health cover up to Rs 5 lakhs per family per year, for secondary and tertiary care hospitalisation services. The healthcare scheme, as per the government claim, covers 50 crore people.

It provides cashless and paperless access to services for the beneficiaries at the point of service -- hospital.

The CAG has included various instances where beneficiaries had to pay cash, despite being covered under the PMJAY. For example, the CAG reports says, “In Himachal Pradesh, 50 beneficiaries of five EHCPs had to manage their diagnostic tests from other hospital/diagnostic centre and cost of tests was borne by the beneficiaries. The amount of expenses was not available with the SHA.”

Similarly, in Jammu and Kashmir, 459 patients paid Rs 43.27 lakhs initially out of their own pocket for which reimbursement was made to the patients after verifying the bills.

Reimbursement is yet to be made to 75 patients amounting to Rs 6.70 lakhs, found out the CAG during the audit.

Saying that in several cases details are not available, the CAG report stated, “In Jharkhand, the insurance company observed that 36 patients of Life Care Hospital, Godda paid varying amounts for purchase of medicines, injections, blood, etc. The details of expenses were not available with the SHA. On the basis of the insurance company's observation, SHA (on August 28, 2020) asked the hospital to submit its explanation within five days to avoid a penalty, failing which the hospital would be suspended. However, the hospital neither submitted any explanation, nor did the SHA initiate any action against the hospital”.

In Meghalaya, out of 19,459 beneficiaries who availed treatment in five private EHCPs from February 2019 to March 2021, 13,418 (69 per cent) had to pay an additional amount of Rs 12.34 crore at the time of discharge, it added.

For the effective implementation of the scheme, the Modi government has set up National Health Authority (NHA) which signed MoUs with 33 States/UTs to implement PMJAY. Despite, beneficiaries paid cash.  

About 1393 treatment packages are available for the beneficiaries under PMJAY, and any beneficiary of PMJAY can approach any empanelled hospital in the country under PMJAY to avail the benefits.

“It is an entitlement-based scheme and does not involve enrolment, or issue of plastic cards,” said the Central government while launching the scheme. 

In a severe indictment of the Modi government, the Comptroller-Auditor General of India (CAG) has revealed that nearly 7.5 lakh beneficiaries registered under the Ayushman Bharat — Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) were linked with a single mobile number — 9999999999.