Maharashtra forms SIT to probe over 15,400 suspicious Ayushman Bharat, MJPJAY medical claims

The Maharashtra government on Wednesday constituted a Special Investigation Team (SIT) to conduct an in-depth probe into 15,407 suspicious medical treatment claims recorded between 2024 and 2026 under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY).

A Government Resolution to this effect was issued on Wednesday, following directives issued during a meeting chaired by Chief Minister Devendra Fadnavis on July 10.

The SIT has been set up under the chairmanship of Nashik Divisional Commissioner Pravin Gedam and it includes senior officials from the Public Health Department, Information Technology Department, Cyber Police, Economic Offences Wing (EOW), and the Health Department.

The SIT will also be supported by expert doctors from the Medical Education Department as needed.

Civil Surgeons and District Health Officers were ordered to physically visit beneficiaries and verify suspicious claims under these schemes.

However, as initial investigations revealed that the alleged irregularities span across multiple districts, the state government decided to launch a comprehensive probe through an independent SIT.

The SIT will investigate various aspects, including fake or medically unnecessary treatment claims at the hospital level, unmerited upcoding of treatment categories, irregularities in hospital empanelment and renewal processes, suspicious patient registrations, multiple claims filed under a single mobile number or identity card, and the potential involvement of Third-Party Administrators, district coordinators, or other stakeholders.

Additionally, the SIT has been tasked with studying flaws in the claim approval process, monitoring mechanisms, and hospital empanelment procedures to recommend necessary reforms to prevent such malpractices in the future.

As per government orders, the SIT must complete its investigation and submit its report to the state government within 30 days.

Further legal and administrative action against those involved will be determined based on the findings of this inquiry.

State Public Health Minister Prakash Abitkar told the State Legislature during the Monsoon session that treatment under MJPJAY and Ayushman Bharat up to Rs 5 lakh is meant to be completely free and cashless.

Emphasising that patients must not be charged "a single rupee" extra, Abitkar warned that hospitals caught extorting additional fees from beneficiaries will face immediate delisting and criminal action, including FIRs.

The Minister said that to prevent private hospitals from falsely claiming non-availability of beds for scheme beneficiaries, the health department announced a real-time bed tracking dashboard.

(Except for the headline, this article has not been edited by Education Post)