Latest news with #SACHIS
Time of India
a day ago
- Health
- Time of India
Crackdown on hosps charging Ayushman beneficiaries
Varanasi: Taking a serious note of increasing complaints from Ayushman card holders that they were charged the treatment cost by listed hospitals, the district administration directed officials of these hospitals to either return the money charged from beneficiaries or be ready to face stern action. As many as 26 beneficiaries have filed complaints for being charged money despite having Ayushman cards. In view of the complaints lodged by Ayushman beneficiaries against hospitals listed under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, chief development officer (CDO) Himanshu Nagpal convened a meeting on Saturday evening. He made it clear that as all beneficiaries are eligible to receive free treatment as per rules and if any expenses have been charged from them during treatment by any hospital, it should be reimbursed immediately. Punitive action would follow in case they do not follow the directives, he said. The CDO added if any hospital is found involved in charging extra money from an Ayushman beneficiary, its association with the scheme would be revoked by notifying senior officials at the State Agency for Health and Integrated Services (SACHIS), while their registration would also be cancelled. Last year, 26 Ayushman card holders lodged complaints against a few hospitals accusing them of charging the treatment cost. Health officials informed the CDO that of the 26 complainants, the money of 20 has been reimbursed so far. Three cases are still being processed and three have been sent to SACHIS. Complaints against at least three hospitals have been forwarded to the state-level controlling authority (SACHIS) for action, said officials. The CDO emphasized that patients visiting listed hospitals must provide a consent form indicating if they hold an Ayushman card, which should be verified using their Aadhaar card on the portal. All affiliated hospitals should update and inform the office about the information, education and communication (IEC) material, help desks and kiosks related to the Ayushman Bharat scheme. The help desk should display the presence of an Ayushman Mitra along with their phone numbers as well as the phone numbers of the hospital. In compliance with Section 28 (Display of Information) of the UP Clinical Establishment (Registration and Regulation) Rules 2016, hospitals should display the specialty registration number, director's name, bed count, method of treatment and services provided along with details of medical staff (doctors, nurses, etc.) on a display board with a yellow background and black Hindi letters. This board should be placed near the hospital's main entrance and a complaint box should also be installed there. Chief Medical Officer Dr Sandeep Chaudhary stated that requests to revoke claims cancelled by contracted hospitals more than six months ago will not be considered as per SACHIS instructions. Hospitals can submit an appeal to the State Grievance Redressal Committee (SGRC) within 30 days if dissatisfied with decisions made on claim forms presented at the district grievance redressal committee meeting. Additional CMOs, including Dr SS Kannaujia, Dr Piyush Rai, and representatives of the hospitals concerned, were present at the meeting.
Time of India
09-06-2025
- Health
- Time of India
Over 6k fake med claims made in 39 hospitals across UPunder Ayushman Bharat
1 2 Lucknow: An alleged scam of Rs 10 crore in fraudulent medical insurance claims under Ayushman Bharat and Mukhyamantri Jan Arogya schemes at several private hospitals of Uttar Pradesh has been busted. An FIR was registered at Hazratganj police station on Monday. BK Srivastava, the state nodal officer of the State Agency for Comprehensive Health and Integrated Services (SACHIS), filed the FIR alleging large-scale irregularities in the processing and approval of medical claims submitted by private hospitals empanelled under the two schemes. The FIR stated that between May 1 and May 22, 2025, a total of 6,239 claims from 39 private hospitals in UP were processed and paid through the centralised online system linked to the National Health Authority's digital portal. A routine audit raised concerns when an unusual volume of high-value claims was processed during odd hours, particularly late at night. Further analysis revealed that the login credentials of key officials, including Implementation Support Agency (ISA) staff, financial officers, and the CEO of SACHIS, were misused to approve these claims without proper scrutiny or authorisation. The fraudulent activity involved unauthorised access and digital manipulation of login IDs such as UP003507, UP008126, UP008171, UP008038, UP008039 (ISA users), UP001730, UP003881 (Finance/Accounts), and UP008296 (CEO-SACHIS). by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like Najbardziej relaksująca gra roku 2025. Bez instalacji Taonga: Wyspa Farma Zagraj teraz Undo Srivastava said these IDs were used to process claims without any online recommendation from the actual users. ISA officials denied any involvement, saying that none of the disputed claims were routed or approved through their system. ACP Hazratganj Vikas Jaiswal said the FIR stated that the timestamps of the transactions indicated deliberate manipulation, as several claims were processed outside normal office hours, suggesting either an insider conspiracy or a highly sophisticated cyber breach. Under Ayushman Bharat scheme SOPs, hospital claims are first submitted on the portal after a beneficiary is treated. These claims are vetted by the ISA, medically audited, and financially verified at SACHIS before being forwarded to the CEO for final approval and payment via banks. However, the scam bypassed this entire chain of checks. The scam came to light when office-level reviews found disproportionate payments being made from the finance manager's login, which was not used by the designated officer at the time of the approvals. Investigations revealed that the login IDs were hacked or misused to clear claims for hospitals not eligible for such reimbursements or had exaggerated treatment data. Irregularities were noticed when payments appeared inflated compared to volume of patients reportedly treated under the scheme. Following internal review and verification from the ISA, it became evident that the online recommendations for claim settlements did not come from the actual users, suggesting a systemic breach. Further audits may reveal a larger figure. Sources said govt has formed an inquiry committee to assess internal lapses within SACHIS.
