Health Ministry defends PMJAY as CAG audit exposes multiple frauds
Context:
The flagship health insurance program of the Centre has come under scrutiny this week due to anomalies uncovered by the Comptroller and Auditor-General. On Wednesday, the Health Ministry defended the program, claiming that cellphone numbers played no part in the verification of its beneficiaries.
What is PMJAY?
Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the government of India’s premier health insurance program, was introduced. It was unveiled in September 2018 as a component of the broader Ayushman Bharat program, which aims to make quality healthcare services accessible to a sizeable segment of India’s population.
AB-PMJAY specializes in helping economically poor and vulnerable groups in society by giving them access to healthcare and financial protection. One of the largest government-funded health insurance programs in the world, the system aspires to cover more than 10 crore (100 million) families, or over 50 crore (500 million) individuals.
What are the features of AB-PMJAY?
- Coverage: The program covers a variety of medical procedures, including hospitalization, surgery, diagnostic exams, prescription drugs, and other medical services.
- Eligibility: Based on specified socioeconomic criteria, the program targets impoverished and disadvantaged families. Beneficiaries are found using a list of deprivation classifications.
- Cashless transaction: Beneficiaries may receive cashless medical care in hospitals and other healthcare facilities if they have an affiliation. As a result, there is no longer a requirement for advance payments for medical treatments covered by the program.
- Portability: The coverage is not limited to a particular region. Benefits are available to recipients throughout India, which is convenient for anyone who might want medical care outside of their native areas.
- No Cap size: No maximum family size is imposed; the head of the home, his or her spouse, and any dependents are all covered.
- Paperless and Cashless Transaction: The plan uses a paperless and cashless transaction paradigm to do business. An e-card is given to beneficiaries, who can use it to access services.
- Empaneled hospitals: Hospitals and other healthcare facilities must register and be approved by the program to offer services to beneficiaries. These accredited facilities follow predetermined treatment plans and payment schedules.
- Services for Prevention: In addition to curative services, the program emphasizes the promotion of preventative healthcare practices.
How did the AB-PMJAY fail in certain areas?
- An insurance program for health is called the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in India.
- During a performance audit, the Comptroller and Auditor-General (CAG) expressed concerns about inconsistencies in the scheme’s implementation.
- The audit report drew attention to instances when the program treated patients who had been pronounced dead and permitted numerous users of the same Aadhaar number or invalid mobile phone numbers.
- Notably, the database for the scheme revealed that a single mobile number (9999999999) was associated with almost 7.5 lakh beneficiaries.
- In Tamil Nadu, hundreds of Aadhaar numbers were used to register thousands of people.
In conclusion, the Health Ministry’s response underscores that Aadhaar verification is the primary identifying method and that mobile phones were not used for beneficiary verification. Changes to the IT portal have been made to solve the problem of several beneficiaries utilizing the same mobile number. According to the Ministry, neither the legality of the claims made under the AB-PMJAY scheme nor the accuracy of the beneficiary verification process was jeopardized by these problems.
