Health Ministry defends PMJAY as CAG audit exposes multiple frauds

CAG report noted that almost 7.5 lakh beneficiaries were linked to single mobile number; Health Ministry says mobile numbers not used in beneficiary validation process

Updated - August 11, 2023 09:45 am IST

Published - August 09, 2023 10:34 pm IST - NEW DELHI

The CAG’s performance audit report, tabled in the Lok Sabha on August 7, 2023, noted multiple cases of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) providing treatment for patients who had already been declared dead. Photo: abdm.gov.in

The CAG’s performance audit report, tabled in the Lok Sabha on August 7, 2023, noted multiple cases of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) providing treatment for patients who had already been declared dead. Photo: abdm.gov.in

With the Centre’s flagship health insurance taking fire over irregularities exposed by the Comptroller and Auditor General this week, the Health Ministry defended the scheme on Wednesday, saying that mobile numbers did not play any role in the verification of scheme beneficiaries.

The CAG’s performance audit report, tabled in the Lok Sabha on Monday, noted multiple cases of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) providing treatment for patients who had already been declared dead, as well as for thousands of people using the same Aadhaar number or invalid mobile phone number.

Bogus numbers

For instance, almost 7.5 lakh people in the scheme’s beneficiary database were linked with a single cellphone number: 9999999999. Almost 1.4 lakh were linked to the number 8888888888, while another 96,000 were linked to another obviously bogus number. There were some similar cases of multiple beneficiaries being linked to a single Aadhaar number as well; in Tamil Nadu, for instance, 4,761 registrations were made against just seven Aadhaar numbers.

In its statement, the Health Ministry said that the scheme only used mobile numbers to reach out to the beneficiaries in case of any need and for collecting feedback regarding the treatment, rather than for any verification purposes.

“AB-PMJAY identifies the beneficiary through Aadhaar identification wherein the beneficiary undergoes the process of mandatory Aadhaar based e-KYC. The details fetched from the Aadhaar database are matched with the source database and accordingly, the request for Ayushman card is approved or rejected based on the beneficiary details,’’ the Ministry said.

‘Random ten-digit numbers’

It further explained that treatment to beneficiaries could not be withheld just on the grounds that the beneficiary does not carry a valid mobile number, or that the mobile number given by them had changed. 

With regard to the use of the same mobile number by multiple beneficiaries, the Ministry noted that initially the mobile number was not a mandatory field during beneficiary verification, and therefore mobile number was not validated in the process. However, since there was a field for collecting mobile numbers, it is possible that some random ten-digit number was entered by the field level workers in some cases, the statement said. However, this would not impact either the correctness of the beneficiary verification process or the validity of the beneficiaries’ claim, the Ministry insisted. Further, necessary changes have been made in the current IT portal used by the National Health Authority (NHA) to capture only valid mobile numbers, in case the same is possessed by the beneficiary, it said.

The Ministry added that the NHA has also provided three additional options — fingerprint, iris scan and face-authentication — for beneficiary verification along with OTP, of which fingerprint-based authentication is most commonly used.

Systemic issues raised

Other key failures exposed by the CAG included private hospitals performing procedures reserved for public hospitals, hospitals with pending penalties amounting to multiple crores of rupees, fraudulent database errors and spending on ineligible beneficiaries, and more systemic issues such as shortages of infrastructure, equipment and doctors at empanelled hospitals, as well as cases of medical malpractice.

According to the report, in the absence of adequate validation controls, errors were noticed in beneficiary databases, such as invalid names, unrealistic date of birth, duplicate PMJAY IDs, and unrealistic size of family members in a household.

‘Dead’ patients treated

The CAG report also said that patients earlier shown as “dead” continued to avail treatment under the scheme. The maximum number of such cases were in Chhattisgarh, Haryana, Jharkhand, Kerala and Madhya Pradesh. The minimum number of such cases were observed in the Andaman & Nicobar Islands, Assam, Chandigarh, Manipur and Sikkim.

“Data analysis of mortality cases in the Transaction Management System (TMS) revealed that 88,760 patients died during treatment specified under the Scheme. A total of 2,14,923 claims shown as paid in the system, related to fresh treatment in respect of these patients,’’ said the report.

Pending penalties

The CAG also noted that penalties amounting to ₹12.32 crore from 100 hospitals were pending in nine States, and that in Andhra Pradesh and Punjab, private hospitals were performing procedures reserved for public hospitals.

In six States and UTs, ineligible households were found to have registered as PMJAY beneficiaries and availed the benefits of the scheme. The expenditure on these ineligible beneficiaries ranged from ₹12,000 in Chandigarh to ₹22.44 crore in Tamil Nadu. In nine States and UTs, there were delays in processing of rejection cases. The delay ranged from one to 404 days.

In several States and UTs, the available equipment in empanelled hospitals were found to be non-functional.

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