CAG report reveals no action taken against defaulters under AB-PMJAY

In its performance audit report on the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, the Comptroller and Auditor General of India revealed that no action was taken against defaulters

New Delhi: In its performance audit report on the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Comptroller and Auditor General of India (CAG) revealed that no action was taken against the defaulters.

The audit noted that 12 hospitals in Jharkhand and one hospital in Assam indulged in various malpractices — illegal collection of money from beneficiaries, repeated submission of same photograph for multiple claims and non-disclosure of facts, etc., as per the CAG report on AB-PMJAY.

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However, follow-up action like recovery of amount of money collected and imposition of penalty, action against errant medical and paramedical professionals, de-empanelment of hospitals etc., had not been initiated, it said. “NHA replied (in August last year) that SHA (State Health Agency) Jharkhand had taken appropriate action against the defaulters but did not furnish any documentary evidence in support of action taken,” the CAG report said.

The reply in respect of SHA Assam was awaited, it added. The report further said it is the responsibility of SHA to design and implement strategies for beneficiary awareness on possible episodes of fraud under the PMJAY. The awareness may include understanding types of fraud, its impact on beneficiaries, preventive measures that the beneficiaries could take and whom to report to. It may be done by using mass media and interpersonal communication at the point of service. “Audit noted that Bihar, Chandigarh and Uttar Pradesh did not plan/conduct anti-fraud awareness activities. The documentary evidence regarding organising of camps for fraud awareness were not made available to audit in any of the selected districts of Himachal Pradesh.

Thus, the aim of apprising the beneficiaries of the possible irregularities in implementation of the programme remained unachieved,” it said. The NHA while accepting the audit observation, replied (in August last year) that innovative measures have been taken for improving beneficiary awareness regarding fraud/abuse, it added.

The AB-PMJAY provides a health cover up to Rs 5 lakh per family per year, for secondary and tertiary care hospitalisation services.

It provides cashless and paperless access to services for the beneficiaries at the point of service — hospital. It may be mentioned that the Ministry of Health and Family Welfare had said it is examining in detail the recommendations of the CAG performance audit report on AB-PMJAY.