1,000 hospitals faced action for AB-PMJAY scheme irregularities
Suitable actions including de-empanelment of 1,114 hospitals, imposition of penalties worth ₹122 crore on 1,504 errant hospitals and suspension of 549 hospitals have been taken against fraudulent entities as reported by the states and Union Territories, the ministry said in a written reply in the Lok Sabha.
AB-PMJAY , a flagship scheme of the central government, was launched in 2018 to provide ₹500,000 annual cashless health insurance cover to eligible citizens for treatment in hospitals across the country.
'Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY) is governed on a zero-tolerance policy towards misuse and abuse and various steps are taken for prevention, detection and deterrence of different kinds of irregularities that could occur in the scheme at different stages of its implementation. A robust anti-fraud mechanism has been put in place and National Anti-Fraud Unit (NAFU) has been set up with the primary responsibility for prevention, detection and deterrence of misuse and abuse under AB-PMJAY,' the ministry said.
According to the terms and conditions of empanelment, hospitals cannot deny treatment to eligible beneficiaries of the scheme. In case of denial of treatment by the empaneled hospital, beneficiaries can lodge grievances. Under AB-PMJAY, a three-tier grievance redressal system has been created at district, state and national level to resolve the issues faced by beneficiaries in utilising healthcare services. At each level, there is a dedicated nodal officer and grievance redressal committees in place to address the grievances of beneficiaries.
'Settlement of claims is an ongoing process. Under AB-PMJAY, claims are settled by respective State Health Agencies (SHA). The National Health Authority (NHA) has laid down guidelines for payment of claim to hospitals within 15 days of claims submission for the intra-state hospitals (hospitals located within state) and within 30 days in case of portability claims (hospitals located outside state),' the ministry said.
'Regular review meetings are organised to take stock of the progress with regards to the claims. Further, capacity building activities are organised for efficient claims settlement,' it added.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Hans India
an hour ago
- Hans India
State withholding Ayushman Bharat for Over-70s, says MP
Mangaluru: Dakshina Kannada MP Capt. Brijesh Chowta on Monday told the Lok Sabha that Karnataka's refusal to fund its share of the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana has left senior citizens in the state without free healthcare. Speaking under Rule 377, Chowta said the scheme, launched last year by the Narendra Modi government, provides citizens aged 70 and above with cashless hospital treatment up toRs5 lakh annually. 'The Karnataka government's refusal to contribute 40% of the cost has effectively stalled its rollout in the state, depriving lakhs of elderly people of critical, life-saving care,' he said. In the Mangaluru region alone, Chowta noted, about 80,000 senior citizens are unable to access the benefit. He urged the Union government to act swiftly to protect the health rights of Karnataka's elderly and ensure that the state implements the popular scheme in full.
Hindustan Times
2 hours ago
- Hindustan Times
104 pvt hospitals empanelled under govt health schemes in 6 months
Pune: In just six months, 104 private hospitals across the district have been added to the state's flagship health insurance programme, Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), and central government's Pradhan Mantri Jan Arogya Yojana (PM-JAY), according to district health officials. Pune, India - Oct. 3, 2023:A view of the board displaying ward no 16 of Sassoon hospital in Pune India, on Tuesday, October 3, 2023. (Photo by Shankar Narayan/HT PHOTO) The Public Health department had launched a state-wide drive in January to expand the network of hospitals empanelled under the two schemes, which provide citizens free or cashless treatment on several procedures and surgeries. Since the launch of the campaign, the number of empanelled hospitals in Pune district has increased from 98 to 202, said the officials. The MJPJAY scheme was launched in 2012 and revamped in 2023 to make it universal and increase the treatment cover from ₹1.5 lakh to ₹5 lakh. Under the PMJAY scheme, beneficiaries are provided coverage of upto ₹5 lakh per year, per family. Currently, there are 1,359 private and 672 government facilities empanelled under both schemes in the state, covering 1,352 health procedures. Dr Priti Lokhande, district coordinator of MJPJAY and PMJAY, said that the newly-added 104 hospitals include private hospitals and medical colleges with 30 beds to 200 beds. 'With a larger number of hospitals getting empanelled, specialised and emergency healthcare will become more accessible to people, especially in semi-urban and rural areas. Twenty five other hospitals are also in the process of getting empanelled,' she said. Dr Nagnath Yempalle, district civil surgeon, said that beneficiaries can avail treatment for a wide range of illnesses, surgeries, and procedures without bearing the financial burden. 'The state health department plans to keep up the drive to ensure that people have more choices for treatment nearer home.' However, charitable hospitals in the city are unwilling to participate. On April 21, the state issued a Government Resolution (GR) making it mandatory for such hospitals to join state and central health schemes. In response, the Association of Hospitals (AOH) in Pune filed a writ petition with the Bombay high court, citing financial and practical difficulties as reasons for their opposition to the government decision.
Time of India
11 hours ago
- Time of India
Karnataka denies universal healthcare access to senior citizens: Dakshina Kannada MP
Mangaluru: Dakshina Kannada MP Capt Brijesh Chowta, in the Parliament, raised the issue of healthcare benefits under , being denied to senior citizens above the age of 70 years, in Karnataka, on Monday. Tired of too many ads? go ad free now Raising the issue under Rule 377, Capt Chowta highlighted that the Karnataka govt refused to contribute its mandatory 40% share under the scheme. This decision left lakhs of elderly citizens without access to healthcare, many of whom depend on the scheme for life-saving treatment. Mangaluru has a senior citizen population of around 80,000 who are above 70 years and are currently missing out on the Rs 5 lakh per year insurance cover for secondary and tertiary care hospitalisation under the scheme, the MP said. He emphasised that this move is in contradiction to Prime Minister Narendra Modi's vision, who launched Ayushman Bharat to ensure universal health coverage and financial protection for the most vulnerable sections of society. The MP said he urged the Union govt to take immediate steps to safeguard the healthcare rights of Karnataka's senior citizens and to direct the state govt to fulfil its obligations under this flagship initiative.
