Abuse of government’s flagship healthcare scheme, Aarogyasri, has come to light once again. A private hospital in the city is suspected to have made false reimbursement claims under Aarogyasri scheme by submitting the same set of X-ray reports of a newborn for several other patients too.
KhabarLive has come to know that the matter is currently under investigation by a committee formed by the Aarogyasri Health Care Trust and if the hospital is found to have committed fraud, it will, in all likelihood, be removed from the list of hospitals empanelled for the scheme.
The hospital had submitted, over the last several months, sets of X-ray reports for as many as 15 newborns and all the reports were found to be of the same baby. The reports were for making claims from the Aarogyasri Trust for the treatment offered.
For the 15 cases, the hospital would have made a claim for Rs 9 lakh as the ‘Ventilator Support Package’ under the scheme costs Rs 60,000 per person. The trust’s officials found that this was done in at least 25 cases. The fraud came to light about two months ago when officials received a complaint from anonymous person.
Aarogyasri Trust CEO Dr K Manohar said that a two-member team, which has been investigating the scam, would conclude its work in a few days and would submit its report. “The hospital is under suspension. They cannot provide treatment and claim charges under the scheme. After a report is submitted on conclusion of the inquiry, a show-cause notice will be issued to it, asking ‘why the hospital should not be de-empanelled’” he said.
Empanelment and Disciplinary Committee of the Aarogyasri Trust will decide if the hospital has to be de-empanelled. A team of external auditors are also inquiring into the case. They will assess the damage caused to the Trust. With this scam coming to light, officials are trying to find out if some other hospitals too are indulging in such malpractices. Aarogyasri Health Scheme provides financial insurance up to Rs 2 lakh per year to BPL families for treatment which needs hospitalisation, surgery, etc.
Some babies, mostly those born premature, have respiratory problem called Hyaline Membrane Disease (HMD) and an X-Ray examination is required to know if a baby is suffering from this condition. If detected, medicines will be given to decongest the infant’s lungs. Another round of X-Ray diagnosis is required to know if the lungs are cleared of the congestion.
All this process serves as proof that treatment has been provided. The hospital in question has submitted one set of X-Ray reports, which show the baby having HMD, as medical records of around 15 babies by changing the name of the baby, date and time in the reports, and claimed charges, officials said.
The Aarogyasri Health Care Trust has cautioned hospitals not to believe mischievous claims that some hospitals’ bills were cleared by the Trust cleared by greasing someone’s palms. It also appealed to the managements not to believe if somebody assures them to get their hospitals empanelled under the scheme.
Trust officials said they received a complaint from a hospital that someone claiming to be an employee of the hospital called them up and assured to get the hospital empanelled under the scheme. “The hospital did pay some money. A complaint was lodged with police and the person was nabbed in Andhra Pradesh” the officials said. #KhabarLive