Una hospital made fake Ayushman cards to raise false medical claims

Lalit Mohan

Tribune News Service

Dharamsala, August 7

The raids conducted by the Enforcement Directorate (ED) and investigations by the State Vigilance and Anti-Corruption Bureau have brought to light an alleged fraud committed under the Ayushman Bharat healthcare scheme in various private hospitals of the state. Ayushman cards have allegedly been misused in various hospitals in the state and several people are involved in the illegal activity.

The hospitals used the fake Ayushman Bharat cards to make false claims under the scheme without the knowledge of the people in whose names these had been made.

Fraud in absence of biometric verification

• The Vigilance has so far identified 69 fake Ayushman Bharat cards that were made in the Una hospital
• The fraud under the scheme was committed between 2019 and 2021 when there was no biometric verification of the patients, which the Centre introduced later

Rajnish Kumar, a shopkeeper in Una, said, “Some person had told me in 2019 that I could get an Ayushman Bharat card in my name and avail of free treatment up to Rs 5 lakh. He referred me to a private hospital in Una where I paid Rs 2,000 for an Ayushman Bharat card. In May this year, I suffered a heart attack and was referred to the PGI, Chandigarh. When I gave my Ayushman Bharat card at the PGI to avail of the free treatment facility, I was told that it was fake. PGI officials threatened me that they would get an FIR registered against me. I pleaded with them that I was innocent and my family paid Rs 1.5 lakh for my treatment.”

Later, Rajnish came to know that the State Vigilance and Anti-Corruption Bureau that was investigating a case against the Una hospital had found out that his Ayushman Bharat card was fake. The hospital had made Rajnish’s Ayushman Bharat card using the details of a Shimla resident, who had a similar name and was a Below Poverty Line (BPL) cardholder.

Vigilance officials explained the modus operandi of the people who had committed the fraud under the Ayushman Bharat scheme. They said that till 2019-2021, there was no biometric verification of people who availed of the benefits of the Ayushman Bharat scheme. The Central Government had appointed Arogya Mitras in private hospitals to help patients get their Ayushman cards made for getting free treatment.

Some private hospitals started misusing this provision and appointed Arogya Mitras. These Mitras picked up the names of BPL cardholders, who were also eligible under the Ayushman Bharat scheme and whose names were available on its portal, and created fake cards for patients having similar names. Interestingly, the nodal agencies in Himachal, which verify the antecedents of people who were issued the Ayushman Bharat cards, could not detect the fraud.

Balbir Thakur, SP, Vigilance and Anti-Corruption Bureau, Kangra, said that they were still investigating the fraud case under the Ayushman Bharat scheme in the Una hospital. He added, “We have provided the details of our investigation to the ED officials on their demand.”