New Delhi: The day when nearly 6 years ago Karishma, the poster girl of Ayushman Bharat was born with great fanfare, a hope that common people of India will not anymore face the grim prospect of being pushed into depth of abject poverty due to out of pocket expenditure on treatment also got delivered.
The first birth of a girl child under this ambitious scheme was announced by Prime Minister Narendra Modi himself visibly exuding pride. He would not have bargained for then that ‘Karishma of Corruption’ will also soon raise its ugly head. The underbelly of this scheme comes off as a veritable study of fake and fraud. The question that confronts policy makers is how to cure AB-PMJAY of the vice like grip of corruption.
It is not a new revelation. CAG (Controller and Auditor General of India) already has long ago exposed the shenanigans in the scheme. The raids by the Enforcement Directorate (ED) of late tumbled upon very rotten within. This has shaken the very foundation of the largest health assurance scheme in the world.
The Enforcement Directorate (ED) on August 3 carried out searches at 19 locations in Delhi, Chandigarh, Punjab, and Himachal Pradesh, including Congress MLA R S Bali, in a case related to the generation of fake Ayushman Bharat AB-PMJAY ID cards and violation of the scheme against many hospitals, including Bankey Bihari Hospital, Fortis Hospital, and others. It came to the fore that medical bills on several occasions have been generated using fake cards, causing loss to the exchequer and the public.
Bali is the Congress MLA from Nagrota and the chairman of the Himachal Pradesh Tourism Development Corporation, and also the vice chairman of the Himachal Pradesh Tourism Development Board.
Officials said that the searches are also being carried out at the premises of Dr. Rajesh Sharma of Shree Balaji Hospital, Kangra, a close associate of the chief minister Sukhvinder Singh Sukhu.
ED’s money laundering probe in the matter was triggered from a first information report (FIR) filed by the Himachal Pradesh State Vigilance & Anti-Corruption Bureau (SV & ACB). The prevention of money laundering act (PMLA) investigation revealed that apart from Bankey Bihari Hospital, Fortis Hospital, Shri Balaji Hospital, Sood Nursing Home, and Sri Harihar Hospital, etc. availed illegal benefits of the AB-PMJAY scheme,” an official said.He added, “During the investigation, as many as 373 fake Ayushman cards were identified, wherein claims of about Rs.40,68,150, were made for reimbursement from the government in the name of treatments given to the said Ayushman Card beneficiaries.
ED officials said that the hospitals have also made claims for treatments, surgery, and admissions, which were actually never given or done to the patients of the Ayushman Card beneficiaries. Investigation also revealed that these hospitals were de-empaneled from the scheme for illegal practices and non-compliance of procedures and guidelines. 8,937 Ayushman Bharat golden cards have so far been scrapped in Himachal Pradesh for alleged violation of the AB-PMJAY scheme. The case involves proceeds of crime of about Rs.25 crore.
There is no doubt that in India where out of pocket expenditure pushes millions below poverty line every year, AB-PMJAY should have been a godsend. Had it been implemented effectively, this scheme would have proved a landmark in the history of Indian public healthcare. Even Even World Health Organization looked at it as having immense possibilities and praised it when it was launched. But corruption waylaid and has turned this into veritable Augean Stable. The expose leading to ED raids is just a tip of the iceberg. If not reformed in time, AB- PMJAY is headed towards becoming a monument of utter failure.
The rosy picture that is being flaunted about the turn around this fully government funded world’s largest health insurance and assurance scheme does not add up given the ubiquitous corruption. Observers of the scheme believe not less than complete overhaul can only ameliorate this scheme.
