How private hospitals in Gujarat are fiddling with lives to mint PMJAY benefits
Deaths of two people in botched surgeries in Ahmedabad hospital reveal treatments under PMJAY were conducted on paper and most patients didn’t need specialised surgeries
The recent death of two patients at an Ahmedabad-based hospital in an alleged case of botched surgery, has opened a can of worms on the alleged misuse of the Pradhan Mantri Jan Arogya Yojna (PMJAY) by private hospitals in the state. While the Gujarat government, last year, suspended the licence of five private hospitals for claiming money under the scheme without actually treating patients, the lesson doesn’t seem to have served its purpose.
‘Hospital claimed Rs 27.7 Cr, operated on paper’
In the latest case, Khyati Multispecialty Hospital, the private hospital where two patients died after undergoing angioplasty on November 11, is found to have claimed Rs 27.7 crore from the government for carrying out 600 cardiology treatments under PMJAY. According to sources, the hospital, over the past six months, has claimed Rs 3.66 crore for conducting 380 angiographies, 220 angioplasties and 36 coronary artery bypass grafting (CABG) surgeries.
Probe conducted into the treatments after the deaths has found that the patients for whom the hospital claimed money were simultaneously registered on patient rolls of other hospitals, indicating that the treatment was merely on paper. A medical team probing the deaths has also found that the many of the patients who were operated upon did not need the specialised surgeries for which the funds were claimed.
While more details on the case will emerge after due investigation, the government has permanently blacklisted the hospital as per PMJAY-MA (Pradhan Mantri Jan Arogya Yojana – Mukhyamantri Amrutam) guidelines.
Free health camp acted as trap
The two deceased patients – 52-year-old Mahesh Girdhar Barot and 75-year-old Nagar Moti Senma – both residents of Borisana village in Mehsana district were admitted to the hospital on November 10 for minor cardiac issues.
According to sources, the patients along with 10 others were contacted by the hospital following a free health check-up camp conducted by the latter in their village on November 9.
Officials say private hospitals do not have the authority to conduct health camps under PMJAY and need permission for special cases. Khyati, however, had conducted the same without permission.
“Private hospitals are not allowed to organise free camps under the PMJAY scheme. In case they do, in special cases in remote areas, a prior permission is required from the department. In this case, the hospital organised the camp without permission,” Dhananjay Dwivedi, the Principal Secretary of Health, Gujarat, told The Federal.
Hospital blacklisted; doctors banned
“Patients admitted at Khyati Hospital were simultaneously admitted to multiple hospitals. This indicates that the treatment was merely a paper exercise. Besides, the department found criminal actions and medical negligence against Khyati Hospital. Hence, it has been permanently blacklisted as per PMJAY-MA guidelines,” Dwivedi said.
The senior bureaucrat said that the doctor attached to Khyati Hospital will not be able to work in any other hospital in the state. “If the owners, trustees or others from Khyati Hospital are associated with any other hospitals, the records of those hospitals will also be investigated for any irregularities under PMJAY,” he added.
An FIR has also been filed against the hospital authorities and the team of doctors who performed the surgery at the health clinic at Mehsana. On November 13, state Health Minister Rushikesh Patel ordered a medical inquiry into the matter.
Patients did not need angioplasty, says probe
A team of doctors from BJ Medical College and hospital who are investigating the deaths have found major differences between the hospital’s post-surgery medical reports and angiography CDs of the patients and have concluded that the patients did not need angioplasty.
The hospital had conducted angioplasty procedures on a total 12 persons from Borisana village, all of whom were beneficiaries of PMJAY.
On Thursday (November 14), 10 of them were summoned to Vastrapur Police station in Ahmedabad and taken to BJ Medical College for check-up.
CAG report exposes embezzlement of funds
The latest case, however, is just one of the many examples of the embezzlement of funds under the scheme in the state over the years.
In 2023, the Comptroller and Auditor General of India (CAG) report revealed that multiple private hospitals across Gujarat had claimed crores of money under PMJAY without actually treating patients. The hospitals claimed to have treated more patients than the number of beds available with them on a per day basis, the report said.
The same year, the public health division of the Gujarat Health Department had suspended the licence of five private hospitals for irregularities in the scheme. These hospitals across Surendranagar, Mehsana, and Ahmedabad claimed to have treated more patients than the number of beds they had. The hospitals had claimed that the patients were PMJAY scheme beneficiaries and had claimed funds from the government for the treatment.
30% of treatments in 2022 were fake: CAG report
According to the CAG report in 2022, the Gujarat government had paid a total of Rs 3507.72 crore under PMJAY, covering 14,12,311 cases out of which nearly 30 per cent of the cases were only on paper.
Between January 2021 and March 2021, a health department investigation found that 50 hospitals across Gujarat that claimed funds under PMJAY scheme were found to have treated more patients than the number of beds they had.
In another incident revealed on March 8, 2021, Surendranagar Medico Multispecialty Hospital had claimed benefits for 97 PMJAY beneficiaries receiving treatment at the hospital. However, the Surendranagar-based hospital had a capacity of just 34 beds on the said date. On further investigation by the health department, it was found that the treatments were recorded on paper only.