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NHA de-empanels 171 hospitals across the country

The National Health Authority (NHA) has de-empanelled about 171 hospitals and imposed penalty of Rs 4.6 crore to several hospitals in nine states for indulging in fraudulent activities in the Prime Minister Narendra Modi’s flagship health insurance scheme: Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Moreover, more than 390 hospitals have been served show-cause notice and suspended in different states.

The National Anti-Fraud Unit (NAFU) at NHA has pointed out that several cases of malpractices among empanelled hospitals. These malpractices have largely occurred in hospitals based in Gujarat, Chhattisgarh, Madhya Pradesh and Punjab. Penalties to the tune of more than Rs 4.5 crores have also been levied on hospitals indulging in malpractices.

The NHA said the National Anti-Fraud Unit has detected suspect e-cards on the basis of algorithms developed internally by it and shared with states for due diligence and action. It ruled out any possibility of a fake e-card being generated automatically by the system, saying the process requires a go-ahead by authorized persons based on supporting documents and final approval of the state health agency officials to not just create an e-card but also to add any additional family member.

The cover provided under PM-JAY is ₹5 lakh per family and not ₹5 lakh per e-card. There is no package under PM-JAY scheme which is free for government. There are certain packages, especially abuse-prone packages, which are reserved for government hospitals by the state authorities. It was detected that private hospitals were performing these government reserved procedures and blocking/submitting the same under a different package name or as unspecified package.

About PMJAY

Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana or National Health Protection Scheme is a national scheme that aimed at making necessary interventions in primary, secondary and tertiary health-care systems, in a holistic fashion.

PMJAY is the world’s biggest healthcare scheme, it aims to cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.

SOURCE: Livemint, Economic Times

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