Patna hospital exploiting dying patients with Ayushman scheme

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), launched with the noble intent of providing health insurance to over 50 crore people, has become a beacon of hope for the underprivileged. The scheme offers up to Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization. However, recent investigations reveal that this lifeline is being manipulated by certain hospitals to exploit patients and siphon off government funds. 

Brijesh Singh, 58, a farmer from Nawada, and Yogesh Yadav, 36, a daily wage laborer, represent the quintessential beneficiaries of the Ayushman Bharat Yojana. Both men, diagnosed with cancer, sought treatment at Mahavir Cancer Sansthan in Patna. Despite exhausting substantial funds from various government schemes, their conditions remain dire, exposing the systemic exploitation within the hospital.

Brijesh Singh and his wife arrived at Mahavir Cancer Sansthan with hope, armed with their Ayushman Bharat card. However, their relief was short-lived. Brijesh’s wife recounts the ordeal: “We were told to buy medicines only from the hospital pharmacy, which were very expensive. Every test was repeated multiple times, and each time we had to pay.”

Despite utilizing funds not only from Ayushman Bharat but also from the Health Minister Cancer Care Fund, CM Medical Relief Fund, and assistance from the PM’s office, Brijesh’s condition showed little improvement. “We have spent nearly Rs. 10 lakhs, yet my husband is still suffering. The doctors don’t explain much to us, and we feel helpless,” she said.

Yogesh Yadav’s story mirrors that of Brijesh. With two young children and a wife relying on him, Yogesh’s cancer diagnosis was devastating. The promise of financial aid through Ayushman Bharat brought a light of hope. But soon, that hope turned into a nightmare. “We were forced to buy everything from the hospital, from bandages to expensive medicines. The tests were done repeatedly, and each time they charged us a lot,” said Yogesh. 

Like Brijesh, Yogesh also exhausted nearly Rs. 10 lakhs, including various government funds. His wife, burdened with the care of their children and ailing husband, expressed her frustration, “We don’t understand why the treatment isn’t working. We trusted the doctors, but now we are drowning in debt.”

The Ayushman Bharat Yojana was introduced to provide comprehensive health coverage to the economically disadvantaged sections of society. The scheme aims to alleviate the financial burden of healthcare by covering secondary and tertiary care hospitalization costs up to Rs. 5 lakhs per family per year. Despite its exclusions, such as outpatient department (OPD) expenses, drug rehabilitation, cosmetic surgeries, fertility treatments, individual diagnostics, and organ transplants, the scheme is a lifeline for millions.

Mahavir Cancer Sansthan, a trust hospital under the Mahavir Mandir in Patna, is under the scanner for alleged exploitation of the Ayushman Bharat Yojana. Patients are reportedly mandated to purchase all medical supplies from the hospital's own pharmacy at inflated prices and undergo unnecessary tests to maximize the use of government funds.

A former employee, speaking on condition of anonymity, revealed the systematic exploitation: “The hospital mandates that all medicines and supplies be purchased from their pharmacy, which charges exorbitant prices. They also repeat tests unnecessarily to inflate bills.”

The issues at Mahavir Cancer Sansthan are not isolated. Across India, the Ayushman Bharat scheme has faced numerous allegations of fraud. In January 2020, the National Health Authority delisted 171 hospitals over alleged scams related to PMJAY. Investigations revealed instances of fake accounts, payments to deceased patients, and other serious lapses. 

The exploitation of patients under the Ayushman Bharat scheme has far-reaching consequences. The financial burden on families like those of Brijesh Singh and Yogesh Yadav is immense, and the emotional toll is even greater. These families, often uneducated and vulnerable, are easy targets for unscrupulous practices.

Brijesh's wife, in tears, shared her despair: “We came here with hope, but now we are in despair. We don’t have any money left, and my husband is still sick.” Similarly, Yogesh’s wife expressed her frustration: “We trusted the hospital with our lives. Now we are left with nothing but debt and a sick husband.”

The government has acknowledged the issues within the Ayushman Bharat scheme and has taken steps to address them. The delisting of fraudulent hospitals and the CAG audit are part of these efforts. However, more needs to be done to protect vulnerable patients and ensure that the scheme fulfils its intended purpose.

Experts suggest several reforms to address these issues. Strengthening the audit mechanisms, increasing transparency, and involving independent third parties in the verification process are some of the recommended steps. Additionally, there is a need for stricter penalties for hospitals found guilty of fraud.

Dr. Abhinav Nikunj, a resident medicine at LCMCH, Bishrampur, Jharkhand says about this Yojana, "The flagship health programme of India, Ayushman Bharat, has increased access to healthcare considerably, covering over 100 million low-income households with insurance and thereby reducing their out-of-pocket expenditures and financial hardship in relation to medical costs. In rural areas, it has constructed better facilities through Health and Wellness Centers and improved the use of healthcare services."

He also added, "Nevertheless, as a doctor with over 5 years of experience in healthcare infrastructure, I must acknowledge the existence of some problems, among them are uneven quality of care by regions, under-funding, and inefficiency in the management system. The scheme also exposes itself to cost inflation risks and possible disparity in the standards of treatment due to reliance on private providers.”

The stories of Brijesh Singh and Yogesh Yadav highlight the dark side of a scheme designed to bring hope to millions. Their experiences at Mahavir Cancer Sansthan expose the stark reality of how the Ayushman Bharat Yojana, despite its noble intentions, can be manipulated to exploit the very people it aims to help.

Education Post tried to contact two senior staff members of the hospital, but both of them refused to comment on this issue.

Brijesh Singh's Plight: After months of repeated tests and expensive medications, Brijesh's health deteriorated instead of improving. His wife, who has been by his side throughout the ordeal, said, “The hospital made us do the same tests again and again, and the medicines were too costly. We thought the Ayushman Bharat card would save us, but we are left with nothing.”

Yogesh Yadav's Agony: Yogesh, once a robust man supporting his family, is now a shadow of his former self. His wife recounts the endless cycle of tests and medication, “Every visit, they asked for more tests. We had to buy everything from their pharmacy, and it drained all the funds we got from various schemes. Now, we are in debt, and my husband is still suffering.”

The exploitation of the Ayushman Bharat Yojana has sparked outrage among the public and healthcare advocates. Many argue that the scheme’s implementation needs a complete overhaul to prevent such abuses. The delisting of fraudulent hospitals is a step in the right direction, but more stringent measures are required to ensure that the funds reach those who need them the most.

Healthcare workers and activists have been vocal about the need for reforms. An ASHA worker, speaking on the condition of anonymity, shared her concerns, “We see many patients like Brijesh and Yogesh. They come to us in desperation, and we can only do so much. The system needs to change. Hospitals should be held accountable for their actions.” 

Dr. Anjali Mehta, a healthcare activist, emphasized the need for transparency, “The Ayushman Bharat scheme is a wonderful initiative, but it’s being misused. We need better auditing and transparency. Patients should be informed about their rights, and hospitals should be penalized for fraudulent practices.”

In response to the rising concerns, the government has increased the allocation for the Ayushman Bharat scheme in the 2024 budget by 10%. This increase is aimed at expanding the scheme's reach and improving its implementation. Additionally, the Health Ministry has defended the scheme, stating that steps are being taken to address the issues highlighted by the CAG audit.