CAG report flags irregularities in PMJAY; 7.5 lakh beneficiaries linked to one mobile number
One of the shocking irregularities that a Comptroller and Auditor General (CAG) report has flagged in the government of India’s flagship national public health insurance scheme, is that 7,50,000 beneficiaries are registered under a single mobile no – 9999999999.
According to the CAG report, submitted in the Lok Sabha on Monday (August 7), this is not an isolated case and there are many beneficiaries of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY), who are registered under a single mobile number. For example, there are more cases they have cited. More than 139,000 beneficiaries are linked to the mobile number 8888888888, while 96,000 beneficiaries are connected to 9000000000, the report said.
What’s more, the report showed that around 20 other mobile numbers have anywhere between 10,000 to 50,000 beneficiaries linked to them. Mobile numbers of beneficiaries were important since they were used to track down records related to any beneficiary in the database.
Besides lakhs of beneficiaries registered under one number, there were errors in the beneficiary database i.e., as the audit found invalid names, unrealistic date of births, duplicate PMJAY IDs, unrealistic size of family members in a household and more.
Households that were not eligible were found registered as PMJAY beneficiaries and had availed the benefits ranging between ₹0.12 lakh to ₹22.44 crore under the scheme, the report said.
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Touted as largest health insurance scheme in the world
AB PM-JAY was launched on September 23, 2018 in Ranchi, Jharkhand by Prime Minister Narendra Modi. Touted to be the largest health assurance scheme in the world, it provides a health cover of ₹ 5,00,000 per family per year for secondary and tertiary care hospitalisation to poor and vulnerable families that form bottom 40 per cent of the Indian population.
The audit report quoting National Health Authority (NHA) records said that 7.87 crore beneficiary households were registered under the scheme, constituting 73 per cent of the targeted households of 10.74 crore in November 2022. But, many errors were noticed in the beneficiary database such as invalid names, duplicate health IDs, incorrect entries in gender fields, unrealistic family sizes, and improbable dates of birth. In Tamil Nadu, seven aadhaar numbers were linked to 4,761 registrations.
NHA response
According to the CAG report, the NHA has agreed with the audit observation and stated in August 2022 that this issue of multiple beneficiaries linked to one mobile will be resolved with the deployment of BIS 2.0. Further, the BIS 2.0 system has been configured so that more than certain number of families cannot use the same mobile number.
“This shall arrest the prevalence of entering “random numbers” which constitute the overwhelming cases of mobile number inconsistency,” the report said.
Also read: Select citizens, middlemen availed of benefits of govt schemes in past: PM Modi
Further, the CAG report also revealed that dead patients continued to receive medical treatment under the scheme. Also, the same patient was simultaneously getting admitted to multiple hospitals during the same period of hospitalisation.
The IT systems were not just okaying pre-authorised requests to dead patients but data analysis during desk audit in July 2020 revealed that the patient could get admitted in multiple hospitals during the same period of hospitalisations, said news reports.
Menwhile, in his written response to the Rajya Sabha, MoS health and family welfare SP Singh Baghel said that the government employs artificial intelligence (AI) and machine learning (ML) to identify potentially fraudulent transactions within the AB-PMJAY scheme.
He said that these technologies serve the purpose of preventing, detecting, and deterring healthcare-related fraud. The minister also disclosed that a total of 24.33 crore Ayushman Bharat cards have been generated under the scheme as of August 1, 2023.
Also, the CAG report highlighted the fact that the empanelled health care providers failed to follow prescribed quality standards and lacked sufficient doctors, infrastructure, and equipment.
