Maha govt forms SIT to probe suspicious claims under Ayushman Bharat and Mahatma Phule Jan Arogya schemes
Mumbai, Aug 5
The Maharashtra government on Wednesday constituted a Special Investigation Team to conduct an in-depth probe into 15,407 suspicious medical treatment claims recorded between 2024 and 2026 under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana and the Mahatma Jyotirao Phule Jan Arogya Yojana.
A Government Resolution to this effect was issued on Wednesday, following directives issued during a meeting chaired by Chief Minister Devendra Fadnavis on July 10.
The SIT has been set up under the chairmanship of Nashik Divisional Commissioner Pravin Gedam and it includes senior officials from the Public Health Department, Information Technology Department, Cyber Police, Economic Offences Wing (EOW), and the Health Department.
The SIT will also be supported by expert doctors from the Medical Education Department as needed.
Civil Surgeons and District Health Officers were ordered to physically visit beneficiaries and verify suspicious claims under these schemes.
However, as initial investigations revealed that the alleged irregularities span across multiple districts, the state government decided to launch a comprehensive probe through an independent SIT.
The SIT will investigate various aspects, including fake or medically unnecessary treatment claims at the hospital level, unmerited upcoding of treatment categories, irregularities in hospital empanelment and renewal processes, suspicious patient registrations, multiple claims filed under a single mobile number or identity card, and the potential involvement of Third-Party Administrators, district coordinators, or other stakeholders.
Additionally, the SIT has been tasked with studying flaws in the claim approval process, monitoring mechanisms, and hospital empanelment procedures to recommend necessary reforms to prevent such malpractices in the future.
As per government orders, the SIT must complete its investigation and submit its report to the state government within 30 days.
Further legal and administrative action against those involved will be determined based on the findings of this inquiry.
State Public Health Minister Prakash Abitkar told the State Legislature during the Monsoon session that treatment under MJPJAY and Ayushman Bharat up to Rs 5 lakh is meant to be completely free and cashless.
Emphasising that patients must not be charged "a single rupee" extra, Abitkar warned that hospitals caught extorting additional fees from beneficiaries will face immediate delisting and criminal action, including FIRs.
The Minister said that to prevent private hospitals from falsely claiming non-availability of beds for scheme beneficiaries, the health department announced a real-time bed tracking dashboard.
— IANS
Reader Comments
The real-time bed tracking dashboard is a brilliant move! Hospitals often deny beds saying they are full when they actually keep them reserved for private patients who pay more. My father was once denied admission to a private hospital under MJPJAY even though they had a vacant bed. I hope the system is implemented properly in all districts, especially in rural areas where awareness is low.
While I appreciate this move, I can't help but think about the bigger picture. The Ayushman Bharat scheme is a lifeline for millions, but corruption at every level—from TPAs to hospital administrators—has been eating into its benefits. I hope the SIT investigation leads to systemic reforms, not just individual punishments. We need transparency in hospital empanelment and claim approval processes, as mentioned in the article.
One of my relatives works in a small private hospital in Nashik and he says many hospitals are actually honest but they have to deal with endless paperwork just to get one claim approved. Some hospitals have even stopped accepting Ayushman patients because payments from the government are delayed for months. I hope the SIT looks into both sides—the fake claimants AND the admin obstacles that force hospitals to take shortcuts.
It's good that they are investigating, but 30 days seems too short for a probe spanning 15,000 claims across multiple districts! These are complex issues involving cyber fraud, hospital collusion, and maybe even misuse by middlemen. I'd rather they take an extra month and do a thorough job than rush and miss out on the root cause of these irregularities.
We welcome thoughtful discussions from our readers. Please keep comments respectful and on-topic.