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2 hospitals suspended from State’s insurance scheme for poor

The insurance scheme is completely cashless and hospitals found guilty of fraud will have to pay a penalty .File PhotoSHIV KUMAR

The insurance scheme is completely cashless and hospitals found guilty of fraud will have to pay a penalty .File PhotoSHIV KUMAR  

45 hospitals have been de-panelled since May for frauds like taking cash from patients

Two hospitals from Nashik and Ahmednagar have been suspended from the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), the State’s medical insurance scheme for the poor. While the Nashik hospital was found to have claimed money for a wrong procedure, the Ahmednagar hospital is alleged to have denied a particular medical package to a patient.

MJPJAY’s chief operating officer Sudhakar Shinde confirmed that the two hospitals were suspended early this month. “The insurance scheme is completely cashless. We don’t want patients to face any problem while availing it,” said Mr Shinde.

While the suspensions can be revoked after the hospitals assure that similar wrongdoings are not repeated, nearly 45 hospitals have been de-panelled from the scheme in May for frauds like taking cash from patients, offering expensive packages beyond the scheme, inflating bills, and refusal to treat under the scheme.

The MJPJAY covers 2.2 crore families for 971 ailments and Rs. 1.5 lakh per year. The beneficiaries are yellow-and-orange ration-card holders. In the 14 farmer suicide-affected districts, the scheme also covers white ration-card holders. The newly launched Pradhan Mantri Jan Aarogya Yojna (PMJAY), also known as Ayushman Bharat, has been integrated with this existing scheme.

In order to curb illegal practices by hospitals under both these schemes, a government circular was released on September 21 which said hospitals would have to pay a penalty of five times the package rate. If a patient is asked to pay any additional amount, the hospital will not only have to return the amount but also pay an additional amount to the government. Besides suspension or de-pannelling from the scheme, the circular also mentions revoking licences if hospitals commit frauds or refuse patients under the scheme. “We have already started noticing the change. The complaints have drastically reduced,” Mr. Shinde said.

360 beneficiaries

Since the launch of the scheme on September 23, more than 360 patients have undergone various procedures under the PMJAY scheme. While the MJPJAY is based on ration cards, the PMJAY beneficiaries have been identified on the basis of Socio-Economic Caste Census. The beneficiaries are issued a ATM-like card with a unique bar code to avail the hospital services.

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