Ayushman Bharat Scheme: Zero Tolerance for Fraud, Grievance Redressal System in Place

New Delhi, Dec 6 (PTI) The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana has a zero-tolerance approach to any kind of fraud and a three-tier grievance redressal system is in place in districts, states and the national level to deal with such issues, the Lok Sabha was told on Friday.

Responding to a question over unnecessary surgeries being done by hospitals empanelled under the PMJAY-Ayushman Bharat Scheme in Gujarat, Minister of State for Health Prataprao Jadhav in a written reply said an FIR has been lodged on November 12 against the hospital and the doctors concerned.

Further, the hospital and the implicated doctors have been suspended from the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), he said.

The minister said that as of November 25, a total of 18,184 grievances have been registered on the Central Grievance Redressal and Monitoring System (CGRMS) pertaining to issues such as denial of treatment, charges for admission, discharge or medicines and the unavailability of Pradhan Mantri Arogya Mitra (PMAM), etc.

"The AB-PMJAY ensures quality healthcare services to the scheme beneficiaries. The scheme is governed on a zero-tolerance approach to any kind of fraud and abuse and various steps are taken for prevention, detection and deterrence of different kinds of fraud that could occur in the scheme at different stages of its implementation," Jadhav said.

The National Anti-Fraud Unit (NAFU) has been established at National Health Authority (NHA) and works in close coordination with State Anti-Fraud Units (SAFU) to investigate and take joint action against issues related to fraud and abuse.

Appropriate actions, including suspension, show cause notice, warning letter de-empanelment of hospitals, de-activation of e-cards, levying penalty on errant hospitals and lodging of FIRs are taken against fraudulent entities, he said.

Under AB-PMJAY, a three-tier grievance redressal system at district, state and national-level has been created to resolve the issues faced by beneficiaries in utilising healthcare, he said.

At each level, there is a dedicated nodal officer and grievance redressal committees to address the complaints. Beneficiaries can file their grievance using different mediums, including web-based portal Centralized Grievance Redressal Management System (CGRMS), central and state call centres, emails, letters to state health agencies, etc.

Based on the nature of grievance, necessary action for resolution is taken, including coordination with the hospital and providing of support to beneficiaries in availing treatment under the scheme.

The AB-PMJAY aims to provide health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to approximately 55 crore beneficiaries corresponding to 12.37 crore families constituting economically vulnerable bottom 40 per cent of India's population.

As on October 31, 2024, a total of 35.8 crore Ayushman cards have been created under the scheme. As on December 2, a total of 20.4 lakh Ayushman Vay Vandana cards have been created under the scheme, Jadhav said.