Gujarat PMJAY fraud | Paediatrician falsely 'treats' 116 healthy infants

According to investigations conducted by the Gujarat Medical Council (GMC), triggered by the death of two patients caused by a botched up angioplasty, Dr Hiren Mashru, a paediatrician and the owner of Nihit Babycare Children Hospital in Rajkot, was found to be falsely admitting new-born babies to the Neonatal Intensive Care Unit (NICU) for long periods and administering treatments that the babies did not need at all.

Also read: How private hospitals in Gujarat are fiddling with lives to mint PMJAY benefits 

Medical malpractice 

The malpractice, which was investigated by the GMC, came to light when one of the staff of the Rajkot-based paediatric hospital leaked Dr Mashru's call records with his staff that revealed how he had instructed the hospital staff to tamper with the patients' reports on the computer.

Dr PK Singh, the Chief District Health Officer (CDHO) told The Federal, “Out of the 524 children admitted in the hospital since July 2023, Dr Hiren Mashru had altered the blood reports of 116 children with perfectly normal health parameters to show they were suffering from various health issues.”

Further, Dr Singh added, “Among other anomalies in reports, we found that the X-ray report of one particular neonatal patient was repeatedly digitally edited and shown to several parents to admit their babies in NICU for a prolonged period of time. This was done to claim the maximum reimbursement from the PMJAY scheme.”

Under the scheme, a patient can claim free treatment up to ₹10 lakh depending on the kind of the disease, he pointed out.

“We conducted a preliminary investigation on the basis of the phone recordings leaked by one of his staff. Dr Mashru was called for questioning and his answers did not seem credible to us. After which, we started our own investigation and then informed the State Health Authority (SHA) of the possibility of malpractice,” Dr Singh said.

Also read: Gujarat doctor arrested for death of PMJAY beneficiaries in botched angioplasty

Licences cancelled

The hospital that was empanelled under the PMJAY scheme for M-3 (neo-natal) treatment, which involves patients who are either neonates or newborns, has now been debarred from the scheme.

The licence of four doctors, Dr Hiren Mashru, paediatrician, Dr Ketan Kalariya, radiation oncologist, Dr Mihir Shah, a surgical oncologist and Dr Prashant Vazirani, a cardiologist, have all been cancelled.

Dr Hiren Mashru, who had claimed ₹65.47 lakh under the PM-JAY scheme, has been fined ₹6.54 crore by the state health commissioner’s department, which is nearly ten times the amount of money he had claimed.

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Medical condition of the babies

Notably, the State Anti-Fraud Unit (SAFU) and the GMC, the two bodies that investigated the matter, are yet to conduct a checkup on the medical condition of the babies, who were kept in NICU and underwent treatment they did not need.

Dr Nitin Vora, the GMC president however explained that the council’s ambit is limited to the professional conduct of medical professionals and the documentary proof before it only.

“The National Anti-Fraud Unit (NAFU) continuously monitors claims under the PMJAY scheme to detect any anomalies in patterns in claims or treatments or amount. The anomalies are immediately red-flagged to the states. This case is one amongst the one that was flagged by the system,” Dr Sailesh Anand, who is the general manager of the PMJAY scheme in Gujarat, said.

Talking to The Federal, he added, “So far, no case of harm to any child had come to our attention or else we would have to look into the matter,” he added.

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Noticeably, unlike other cases of PMJAY fraud, no family members of patients have come forward to register a police complaint against the Rajkot-based hospital as yet.

The authorities have declined to answer if the children are currently admitted in any other hospital or have been sent home.

Suspension of licences in six other cases

Meanwhile, a week after two patients died at Ahmedabad-based Khyati Multi-specialty hospital due to a botched up angioplasty, conducted to exploit the PMJAY scheme, a government probe into the misuse of PMJAY scheme in private hospitals, is shaking up the medical fraternity in Gujarat.

The Gujarat health department has currently suspended the licences of six other hospitals –  Shri Jivan Jyot Arogya Seva Sangh in Gir Somnath district, Khyati Multispeciality hospital, Naritva Turning Point Health Care Pvt Ltd and Shiv Hospital in Ahmedabad, Sunshine Global Hospital in Surat and Sunshine Global Hospital in Vadodara.

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While the investigation is yet to be completed in six cases, the one involving Nihit Babycare Hospital in Rajkot has been concluded and the licences of the doctor and hospital have been cancelled by the authorities.

The results of the investigations into the other six other hospitalks are still underway.