PM-JAY Scheme Misused by Private Hospitals in Gujarat

Ahmedabad : The Pradhan Mantri Jan Arogya Yojana (PM-JAY), a key healthcare initiative under Ayushman Bharat intended to provide free treatment for over 12 crore underprivileged families in India, appears to be facing significant misuse. According to a 2023 audit report by the Comptroller and Auditor General (CAG), several private hospitals in Gujarat have allegedly exploited the scheme to generate income rather than serve those in need.

PM-JAY was launched with the noble objective of offering poor and vulnerable citizens free medical care. However, some private hospitals have reportedly turned this scheme into a revenue stream by exaggerating patient counts and submitting inflated claims. The CAG report highlights a range of irregularities, with cases of hospitals treating more patients than their actual capacity and issuing claims for treatments that may only have been recorded on paper.

Between January and March 2021, auditors visited 50 hospitals in Gujarat to investigate the scheme’s implementation. These hospitals collectively had 2,552 beds but reportedly treated 5,217 patients on various days—more than double the capacity. For instance, at Surendranagar Medico Multispecialty Hospital on March 8, 2021, 97 patients were allegedly under treatment against the hospital’s capacity of only 34 beds. The report suggested that a significant portion of these treatments might have existed solely on paper.

A more concerning revelation was that some patients were registered as receiving care in multiple hospitals simultaneously. This anomaly, affecting 21,514 patients, indicated potential fraud where claims were made without genuine treatment. The report noted that despite these irregularities, the state health department continued to disburse payments to the hospitals involved. By November 2022, Gujarat had paid ₹3,507.72 crore for 14,12,311 cases under PM-JAY, raising concerns over insufficient oversight.

A prominent case mentioned in the report is that of Khyati Hospital in Ahmedabad, which has faced scrutiny following the deaths of two patients from Kadi who underwent angioplasty procedures. Allegedly, these procedures were conducted purely to benefit from PM-JAY funds, rather than out of medical necessity. In total, Khyati Hospital has claimed ₹27.7 crore for over 600 cardiology treatments under PM-JAY, including 380 angiographies, 220 angioplasties, and 36 coronary artery bypass grafting (CABG) surgeries.

The scale of Khyati Hospital’s claims is striking, with the hospital reportedly seeking ₹3.66 crore in a span of just six months. In an unusual spike, the hospital allegedly filed claims for 650 cases between June 1 and June 12 alone, raising suspicions of malpractice. Such large-scale claims and frequent procedures hint at potential misuse of PM-JAY funds, prompting further investigations.

These findings have sparked questions about the efficacy of the scheme’s oversight and monitoring mechanisms. The apparent lack of accountability has led to substantial payouts to private hospitals, often without verification of the treatment provided. With PM-JAY funds meant to uplift the healthcare access of vulnerable populations, stricter regulatory measures may be required to curb such practices and ensure funds are not misused.