Latest news with #AyushmanBharat–PradhanMantriJanArogyaYojana
Hindustan Times
2 days ago
- Health
- Hindustan Times
1,000 hospitals faced action for AB-PMJAY scheme irregularities
More than one thousand hospitals across the country have faced actions, ranging from de-empanelment and levying of fines, in connection with irregularities while implementing the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) since the launch of the scheme, according to the data shared by the Union health ministry in Parliament on Friday. 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.
The Print
5 days ago
- Health
- The Print
Why 650 Haryana hospitals have halted AB-PMJAY services, in move set to hit 1.4 crore beneficiaries
The Centre's flagship health insurance scheme, AB-PMJAY, provides Rs 5 lakh annual coverage per family for secondary and tertiary hospitalisation, benefitting over 12 crore economically vulnerable families across India. Of them, 1.364 crore beneficiaries are from Haryana. The Indian Medical Association, Haryana, has declared a complete halt in the implementation of the scheme in private hospitals over pending dues estimated at Rs 500 crore. According to IMA, Haryana, nearly 650 private hospitals have not received reimbursements this quarter, and some dues have been pending for over a year now. New Delhi: Haryana private hospitals empanelled under the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have suspended services under the healthcare scheme, citing non-payment of reimbursements by the state government. On 6 August, at an emergency meeting with Haryana's chief secretary and senior health officials, the IMA learnt that Haryana had released Rs 145 crore and the Centre Rs 70 crore for the scheme implementation in the current quarter. Even with Rs 245 crore paid by the two governments—an IMA statement said—dues of Rs 490 crore are still pending. 'The root of the problem is the budgetary mismatch,' said Dr Suresh Arora, a senior consultant at Surya Ortho & Trauma Centre in Faridabad, which is among the private hospitals suspending services under AB-PMJAY. 'Haryana's annual budget for the scheme is nearly Rs 700 crore, but actual expenses exceed Rs 1,400–1,500 crore. This shortfall has persisted for the last three years.' His hospital alone has pending dues of Rs 20 lakh. ThePrint has learnt that another large, multi- or super-speciality hospital, the 2,600-bed Amrita Hospital, which Prime Minister Narendra Modi inaugurated in Faridabad on 24 August 2022, is yet to be reimbursed Rs 18 crore under the scheme. A total of 32,736 hospitals are empanelled under AB-PMJAY across India, including 15,024 private and 17,712 government hospitals. Haryana currently has 1,341 empanelled hospitals, according to official data. 'This has become a pattern every three months,' said Dr Dhirendar K. Soni, the secretary of IMA Haryana. 'Payments delayed, hospitals threaten to suspend services, and then a part of the money is released.' Also Read: Chhattisgarh pvt hospitals are gaming Ayushman Bharat PMJAY. It's the state with 2nd highest frauds 'Interest clause not honoured' Hospitals also allege that the Haryana government has failed to honour a key clause in the Memorandum of Understanding (MoU)—paying interest on delayed payments. The original MoU included a clause for interest payment in the case of delayed payments under the PM-JAY scheme, but states like Haryana reportedly have removed it. 'Not only is that not paid, but we are also seeing deductions in reimbursements,' said Dr Arora. 'They are rejecting cases on flimsy grounds, not offering additional payments to NABH-accredited hospitals—those certified for maintaining higher standards of care and patient safety—and in some cases, reimbursing only Rs 4,000–5,000 on bills worth Rs 18,000.' An IMA delegation, which previously met Chief Minister Nayab Singh Saini in February to raise these concerns, 'was assured of a resolution, but nothing has happened since', Dr Soni said. Dr Girdhar J. Gyani, Director-General of the Association of Healthcare Providers of India (AHPI), which represents over 15,000 private hospitals, including major chains such as Fortis, Max, Manipal, Medanta, and Apollo, pointed out two structural issues with the scheme. One issue, Gyani noted, was the lack of a strict clause in the scheme for interest payments to empanelled hospitals in the case of delays to ensure timely reimbursements by governments. 'If the one percent interest clause applied on delays beyond the 15-day agreement period, officials would be more accountable,' he said. In the current setup, the government often defaults on payments, leaving smaller hospitals grappling with severe cash flow challenges. Different states, same challenges The primary issue with the scheme, Dr Gyani said, was inadequate funds allocation. Haryana is not alone. Newly joining states such as Delhi and others, including Chhattisgarh, are also grappling with reimbursement delays and mounting dissatisfaction among private hospitals under the AB-PMJAY. Delhi has 143 empanelled hospitals, including public and private facilities. A reply to an RTI filed by activist Dr Ajay Basudev Bose in February this year revealed that dues of Rs 1,21,61,45,63,617 under the scheme are pending across India. Earlier, ThePrint reported that several large hospital chains were reluctant to join the scheme due to consistent non-payment. Dr Gyani said that several states, including Tamil Nadu, Andhra Pradesh, Telangana, Maharashtra, and Gujarat, had expanded the coverage under AB-PMJAY, surpassing the number of socio-economically eligible beneficiaries initially identified under the national guidelines. Now, these states are supposed to bear the excess coverage costs from their treasury, but many, however, do not have the funds, he added. Dr Gyani also raised concerns about the Central Government Health Scheme (CGHS), which offers highly subsidised healthcare, mainly private healthcare, to central government employees and pensioners. 'CGHS [core] rates have not been revised since 2014, despite inflation. The government is now proposing a new agreement, with more stringent conditions, but without updating the rates,' he said. Many hospitals would likely withdraw from CGHS, as well, if the government approved the conditions but did not update the rates, he added. (Edited by Madhurita Goswami) Also Read: No doctor or ICU—small pvt hospitals drive AB-PMJAY fund misuse in Chhattisgarh as monitoring lax
News18
05-08-2025
- Health
- News18
Why Haryana's Public Health System Is Crumbling With Pending Dues From Ayushman Bharat
Haryana's public healthcare system is collapsing under the weight of over-promising, financial mismanagement, and a lack of strategy In an attempt to manage shrinking healthcare funds, the Haryana government in June dropped several high-demand treatment packages—including cataract, hysterectomy, laparoscopic cholecystectomy, gastroenteritis, and Chronic Obstructive Pulmonary Disease (COPD)—from both the Ayushman Bharat and Chirayu Yojana health insurance schemes for private hospitals. While that decision is still rippling across hospitals and patients alike, another storm is brewing: over 650 private hospitals are preparing to halt Ayushman Bharat services starting August 7, citing unpaid dues of over Rs 500 crore. But this isn't just a payment delay issue. Haryana's public healthcare system is collapsing under the weight of over-promising, financial mismanagement, and a lack of strategy. How Did We Get Here? Haryana's health insurance net has grown rapidly in recent years. Under the Centre's Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the state covered about 70–80 lakh beneficiaries. But in a bid to widen the safety net, the state launched Chirayu Yojana, expanding total coverage to a staggering 1.8 crore people—over 70 per cent of the state's 2.5 crore population. This expansion was not backed by a scalable financial roadmap. 'In trying to serve too many, the government is now unable to serve anyone properly," said Dr Ajay Mahajan, former president of the Indian Medical Association (IMA), Haryana. 'They over-promised but didn't have the budget to sustain it." Mahajan was IMA Haryana's president when the dialogues with the state government started for expanding the funding. 'In 2023–24, the total budget for these health schemes was Rs 1,300 crore, which increased to Rs 1,800 crore in 2024–25. During multiple meetings with the chief minister and his office, private hospital representatives were assured that the allocation would rise to Rs 2,000–2,500 crore. Instead, it was slashed to Rs 700 crore—causing a severe funding crisis." 'That entire amount of Rs 175 crore, from the first quarterly release, officials confirm, has already been used to clear old unpaid dues from previous years, leaving this year's reimbursements pending. Rs 175 crore has been used to clear old dues. There is no money left to clear the latest dues." Why Top-Selling Packages Were Removed In a notice titled 'Regarding Reservation of Medical & Surgical Packages for Government Hospitals", issued on 23 June 2025, seen by News18, the Ayushman Bharat Haryana announced that five high-demand procedures would now be reserved exclusively for public (government) hospitals. They labelled the move as part of efforts 'to streamline package utilization under Ayushman Bharat HHPA and to avoid over-utilization by private empanelled hospitals." The five procedures—Phacoemulsification with foldable hydrophobic acrylic IOL, Abdominal Hysterectomy, Acute Exacerbation of COPD, Acute Gastroenteritis with Severe Dehydration, and Laparoscopic Cholecystectomy (Without CBD Exploration)—are in addition to 114 packages already reserved for government facilities. The notice further directed officials to 'update the TMS portal accordingly, so that booking of these packages is restricted to Government Hospitals only," adding that the step will 'enhance service delivery at public health institutions and ensure judicious use of scheme funds." However, IMA Haryana and other private hospitals believe that the move is to cut budget under the scheme as these packages, especially cataract surgery, had very high demand. 'The more the packages sold in private hospitals, higher the bills for reimbursement become pending," Mahajan said. About 700 private hospitals in Haryana are empanelled under the scheme—many of them mid-sized nursing homes and speciality centres that serve 90 per cent of Ayushman patients. The public sector, though nearly equal in number of hospitals, attracts only 10 per cent of patients. 'Most tertiary care and super-speciality beds—about 80–85 per cent—are with private hospitals," said Dr Girdhar Gyani, director general of the Association of Healthcare Providers India (AHPI). 'These hospitals cannot survive long payment delays. The government's intent may be genuine, but without a strategy and cash flow, the system is breaking down." Hospitals say they are facing operational stress, rising costs, and zero liquidity. Payments have been delayed by up to five months in some cases. Arbitrary deductions and administrative apathy have only added to the strain. 'The only solution is to charge 1 per cent interest as a penalty for the amount due. This penalty was part of the original Ayushman Bharat scheme when launched in 2018. However, states have removed that clause due to their own convenience." Quiet Cuts, Loud Consequences To deal with the mounting costs, the government has begun cutting down packages. Mahajan confirmed to News18 that several high-volume, commonly claimed procedures were quietly removed from the Ayushman and Chirayu lists months ago. These include cataract surgeries, hysterectomies, gallbladder removals, and even procedures related to gastrointestinal and COPD conditions. 'Cataract was the top-selling procedure, and they have removed that as well." 'These five were core treatments, especially for the poor," he said. 'Removing them doesn't just balance the books—it leaves lakhs of people with no option but to pay out of pocket or skip care altogether." The cost of running both schemes simultaneously, Mahajan said, has created an unsustainable financial burden, with the state now facing the consequences of overpromising. Last-Ditch Talks, With Conditions top videos View all Talks between the government and hospital associations are ongoing. A meeting scheduled on Monday was postponed, but fresh dates have been proposed. Hospital leaders say they're still open to negotiation. 'We were planning to meet the state government officials today, but the meeting was cancelled," Gyani said, adding, 'If we get a firm assurance and timelines, we might give them a week's extension. But if the funds are not released soon, we will have no choice but to stop services. We simply don't have the money to treat patients under Ayushman." About the Author Himani Chandna Himani Chandna, Associate Editor at CNN News18, specialises in healthcare and pharmaceuticals. With firsthand insights into India's COVID-19 battle, she brings a seasoned perspective. She is particularly More Get breaking news, in-depth analysis, and expert perspectives on everything from politics to crime and society. Stay informed with the latest India news only on News18. Download the News18 App to stay updated! tags : Ayushman Bharat cataract gall bladder haryana news18 specials view comments Location : New Delhi, India, India First Published: August 05, 2025, 12:20 IST News india Why Haryana's Public Health System Is Crumbling With Pending Dues From Ayushman Bharat Disclaimer: Comments reflect users' views, not News18's. Please keep discussions respectful and constructive. Abusive, defamatory, or illegal comments will be removed. News18 may disable any comment at its discretion. By posting, you agree to our Terms of Use and Privacy Policy.
New Indian Express
26-05-2025
- Politics
- New Indian Express
Andhra Pradesh social welfare minister distributes Rs 35 lakh CMRF aid, slams Jagan over planned Podili visit
ONGOLE: Social Welfare Minister Dola Sree Bala Veeranjaneya Swamy on Sunday handed over cheques amounting to Rs 35 lakh of Chief Minister Relief Fund (CMRF) to 49 beneficiaries from the Kondapi Assembly segment at his Turpu Naidupalem camp office. The minister interacted with beneficiaries' families, enquired about their health and treatment progress, and wished them a speedy recovery. He stated, 'Chief Minister Chandrababu Naidu has saved many lives through the CMRF. The TDP-led NDA government is committed to the welfare and health of the poor.' Dola emphasised that the State government prioritises the welfare of marginalised communities. 'Our government is a poor man's government. We will implement the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (PM-JAY) scheme for all senior citizens aged 70 and above, offering free health services worth up to Rs 5 lakh,' he added. Dola slammed the YSRCP president YS Jagan Mohan Reddy over his visit to Podili on May 28 as part of the 'Porubata' programme demanding fair prices for tobacco farmers.
News18
26-05-2025
- Health
- News18
Ayushman Card: 70+ Senior Citizens Can Now Get Rs 5 Lakh Free Medical Cover Via App; How To Apply?
Last Updated: The central government has simplified access to free medical treatment worth Rs 5 lakh per year for senior citizens aged 70 and above under Ayushman Bharat-PMJAY. In a significant step toward universal healthcare, the central government has simplified the process for senior citizens aged 70 years and above to access free medical treatment worth Rs 5 lakh per year. As part of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Ayushman Vay Vandana Card can now be applied for directly through the Ayushman App, making high-quality healthcare more accessible to India's elderly population. What Is Ayushman Vay Vandana Card? The Ayushman Vay Vandana Card is a special health ID card under the flagship Ayushman Bharat scheme. It aims to provide comprehensive free treatment up to Rs 5 lakh annually per family at empanelled public and private hospitals across India. This initiative, launched by Prime Minister Narendra Modi in 2018, is the world's largest government-funded health assurance scheme, covering over 55 crore people, or nearly 40 per cent of India's vulnerable population. 'Senior citizens aged 70 and above can now get their Ayushman Vay Vandana Card through the Ayushman App and access Rs 5 lakh of free treatment. Watch this video to learn how to create Ayushman Vay Vandana Card and unlock essential healthcare benefits," the Ministry of Health said in a post on X on May 25, 2025. From October 29, 2024, all citizens aged 70 and above, regardless of income or social background, have become eligible for this benefit, marking a historic expansion of the scheme. Why This Matters Healthcare costs are a major burden for senior citizens, especially those without regular income or insurance. By simplifying the application process and expanding coverage, this move enhances Ease of Access, Affordability, and Assurance — the three pillars of Ayushman Bharat. As per government data, a total of 65,97,096 applications have been received. Out of this, 64,96,101 have already been approved. While 96,203 are pending, a total of 4,792 applications have been rejected for various reasons. A total of 434 cards have been distributed. States with the highest number of applications include Madhya Pradesh, Uttar Pradesh, Kerala, Gujarat, and Chhattisgarh. Who Can Apply? Note: Income is not a barrier. Even if you are not from the Economically Weaker Section, you are still eligible as long as you are 70 or older. Documents Needed How to Apply for Ayushman Vay Vandana Card? You can apply through two simple ways: via mobile app or the official website. Apply via Ayushman App (Mobile Method) Download the Ayushman App from Google Play Store. Open the app and log in as Beneficiary. Enter your mobile number and captcha, then verify via OTP. Select 'Enrollment for 70+'. Enter Aadhaar details, complete e-KYC. Fill in the required details and upload a photo. Submit the form. Your Ayushman Card will be available for download within minutes. Apply via Official Website Visit the Ayushman Bharat website. Enter your mobile number and captcha, log in via OTP. Click the 'Enrollment for Senior Citizens (70+)' banner. Enter Aadhaar number – complete e-KYC via OTP/biometrics. Fill in details, give consent, upload a live photo. Submit the form. Card will be ready to download in 15-20 minutes. Need Help? If you face issues while applying, call the toll-free helplines: 14555 1800-11-0770 Available 24×7 across India. Why You Should Apply Now This card can save lakhs in medical bills. Whether it's heart surgery, dialysis, cancer treatment, or any other critical care, being enrolled in PM-JAY ensures senior citizens receive timely treatment without financial stress. Given the high number of pending applications and limited card distribution so far, it is recommended to apply early and secure your healthcare coverage. Stay updated with all the latest business news, including market trends, stock updates, tax, IPO, banking finance, real estate, savings and investments. Get in-depth analysis, expert opinions, and real-time updates—only on News18. Also Download the News18 App to stay updated! tags : Ayushman Bharat Location : New Delhi, India, India First Published: May 26, 2025, 11:22 IST News business » economy Ayushman Card: 70+ Senior Citizens Can Now Get Rs 5 Lakh Free Medical Cover Via App; How To Apply?
