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The institution responsible for the audit of government expenses, the Comptroller and Auditor General of India (CAG), has brought to light significant shortcomings in the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana scheme in a report. In its report, CAG has stated that nearly 7.5 lakh registrations under the Ayushman Bharat scheme were made through just one phone number.  There is another phone number on which 1.39 lakh different registrations were recorded.

The report also reveals that there are several individuals registered under the scheme who were actually not eligible for registration. These ineligible individuals have benefited from the scheme by receiving benefits of up to Rs 22 crore. The report questions the standard of hospitals associated with the scheme and also highlights instances where beneficiaries were charged separately in certain states.

In some states, authorities coming under the Ayushman Bharat network made so many mistakes in the entries of records that in some instances it has been recorded that the patient was discharged on a prior date and his surgery was conducted on a later date.

Moreover, in some cases, authorities had made payments on the death of the patients without procuring proper death certificates.

CAG presented its report in Parliament on Tuesday regarding the Ayushman Bharat scheme, leading to the revelation of all this information.

Shortcomings in Ayushman Bharat Scheme:

a) Lacuna in beneficiary identification and registration process:

Because authorities didn’t properly follow validation processes, some beneficiaries had registered invalid names under the Ayushman Bharat scheme. Unrealistic date of birth have been recorded in case of numerous beneficiaries. Some even have duplicate PMJAY IDs. While, some have recorded unrealistic size of family members of the beneficiaries.

b) Questions on standards of empanelled hospitals

Empanelled Health Care Providers (EHCPs) under the scheme neither fulfilled the minimum criteria of support system nor had proper infrastructural facilities. The facilities provided by the EHCPs were not in sync with the guidelines mentioned under the Ayushman Bharat scheme.

Some people even had to make payments from their own pockets while undergoing treatment in the  EHCPs despite being registered under the scheme.

c) Delay in grievance redressal

Authorities caused delay in redressal of 87.33 per cent of total 37,903 grievances filed under the Ayushman Bharat scheme.

d) Mismanagement of funds in excess of Rs 1,133 crore

Some people got registered under Ayushman Bharat scheme and as well as under other state specific schemes leading to overlapping. As a result, some EHCPs got extra subvention of Rs 57.53 crore from the government of India.

National Health Authority (NHA) has paid extra grants to many states. In many cases, it was found that State Health Authorities (SHA) were sitting on piles of administrative grants received which amounted to crores of rupees. The SHAs are sitting with the administrative grants instead of spending the money on the treatment of the poor and impoverished.

West Bengal after withdrawing from the PMJAY in January 2019 has not yet refunded Rs 31.28 crore to the  NHA.

In a nutshell, all relevant authorities be it NHA or SHAs or insurance companies are involved in some way or the other in huge mismanagement of funds amounting to more than Rs 1,133.86 crore

The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana was launched the the government of India to provide Rs 5 lakh health cover to every family in a single year.

Accordig to NHA, as of November 2022, 7.87 crore beneficiary have been registered under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana against the GoI’s target of 10.74 crore households.