Sarbat Sehat Bima Yojana: Hospitals, not beneficiaries, reaping scheme’s benefit in Amritsar district

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Amritsar, April 25

With the reports of insurance fraud pertaining to Ayushman Bharat-Sarbat Sehat Bima Yojana, a flagship programme of the government to help people get medical care at government and private hospitals, questions are being raised on the scheme as a few unscrupulous hospitals and not the eligible beneficiaries are reaping its benefit.

Sources in the Health Department said reports have been received regarding private hospitals committing fraud by falsifying reports and records of treatment by which the expenditure shown on treatment of an insured person is shown as much more than the actual expenditure.

Earlier also, such frauds with insurance schemes including the one meant for ex-servicemen had come to light. The eligible beneficiaries of the AB-SSBY have often complained of not getting the benefit. Many of them have to pay for the treatment even though they are eligible for a free of cost treatment of up to Rs. 5 lakh per family.

The district has a total of 105 hospitals empanelled under the Sarbat Sehat Bima Yojana, of which 10 are government hospitals and the remaining are private hospitals. Sources in the department said a few private hospitals have been found manipulating health records for fraudulent economic gains.

The health officials said recently a private hospital was fined Rs. 3 lakh for issuing falsified diagnosis reports.

The Civil Surgeon said: “If any empanelled hospital is found committing any fraud, recommendation will be sent to the state authorities for further legal action. The audit of the empanelled hospitals is regularly conducted by the Health Department as well as the insurer.”

Sarbat Sehat Bima Yojana

• The district has total 105 hospitals empanelled under the scheme, of which 10 are government hospitals and the remaining private
• Reports have been received regarding private hospitals committing fraud by falsifying reports and records of treatment by which the expenditure shown on treatment of an insured person is shown much more than the actual expenditure