871 patients denied treatment under MJPJAY in 5 years; 55 cases from Mumbai; 545 Hospitals de-empanelled since 2013
MUMBAI: Over five years, 871 patients involved their district-level Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) officials after local hospitals denied them treatment under the scheme.
Of these, 55 cases were reported in Mumbai.
The data is part of a response to an RTI filed by activist Jitendra Ghadge, who said, "There are around 6,500 hospitals in Maharashtra, but only 2,019 are enrolled in these schemes, that's just 31%. Even those empanelled hospitals are denying treatment to the poor. This shows serious flaws in the implementation of the scheme."
However, MJPJAY officials insist the data is misleading when read without context.
"From 2019-20 to 2024-25, 58 lakh cases received pre-authorisation for treatment under the scheme. In comparison, the 871 complaint cases are very few and exceptional," said Aannasaheb Chavan, CEO of MJPJAY. He added that many of these cases were resolved immediately after district coordinators intervened.
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Dr Rameshwar Kumbhar, who heads the grievance cell, said, "The scheme covers only specific treatments and ailments.
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In some cases, patients file complaints against hospitals for not providing procedures that are actually not covered under the scheme."
With 181 complaints, Sangli saw the highest number of patients who involved local officials. One official there said, "There are many procedures for which the scheme provides insufficient cover. In such cases, hospitals ask patients to pay the remaining amount out of pocket, and the agitated patient or relative lodges a complaint with us.
In many cases, we make the hospital reimburse the out-of-pocket amount."
Dr Kumbhar added that when investigations by local officials reveal that hospitals have unreasonably denied treatment, those hospitals are either suspended or de-empanelled from MJPJAY. A total of 545 hospitals have been de-empanelled since the scheme began in 2013.
Some representatives of these hospitals told TOI that a number of issues made it difficult to keep the scheme functional.
"There were delayed payments, lack of manpower to handle such patients in smaller hospitals, and technical glitches," said a former doctor from one of the previously empanelled city hospitals.
Chavan stated that reimbursements are made on a quarterly basis.
"There were some issues earlier. By the end of March, we released about Rs 1,500 crore. In this case, there were some delays, but all have been resolved. We are releasing another Rs 400 to Rs 500 crore for the April-June period in another week."
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