Health scheme chief poses as a patient to expose how hospital cheats the poor

The poor shall get their due. Sudhakar Shinde is ensuring that. The newly-appointed CEO of Mahatma Jyotiba Phule Jan Arogya Yojana — the state-run health insurance scheme — is cracking down on hospitals that are swindling funds meant for poor patients.

He has already launched action against Balaji Hospital, a 100-bed hospital in Byculla, for a number of irregularities related to the treatment of poor patients. Suspecting that the fraud at Balaji Hospital is only the tip of the iceberg, officials are now extending their investigation to other hospitals.

Patients with an income below Rs 1 lakh can get free treatment under the health insurance scheme. But Shinde found out during an undercover operation on May 19 that Balaji hospital inflated bills, wrongly diagnosed health conditions/diseases, and fudged medical reports as well as discharge summaries on seven occasions. Each of those times, patients were allegedly charged by the hospital despite payments being sanctioned under the insurance scheme.

The hospital has been suspended from the scheme, pending an inquiry, as have been three Arogya Mitra officers, whose sole task was to prevent such malpractices. The hospital can be de-empanelled, and even lose its registration, depending on the inquiry committee’s findings.

The hospital is also suspected to have misappropriated funds under other schemes, like the chief minister’s fund.

Mohammad Waris, senior manager (operations) of the scheme, said officials are looking into last three months’ records at Balaji hospital to see how far back the rot goes.

Blowing the lid

Shinde, former Panvel civic commissioner who took charge as the CEO of the Yojana on May 15, said he started his crackdown with Balaji hospital after noticing irregularities in its bills. “That same day, I visited the hospital, posing as a patient,” he said. “I came across patients suffering from cardiacrelated ailments being overcharged and authorities misguiding them with the claim that their treatments were not covered by the scheme.”

He said in other cases, the hospital management failed to reimburse patients who shelled out money for emergency treatments, after the file was cleared.

“I realised that many hospitals must be misusing the scheme. We will not tolerate this. Stringent action will be taken against all errant hospitals,” he warned.

An eight-member vigilance team is visiting all 52 empanelled hospitals in the city and the suburbs to look into irregularities. Shinde has also sent warning letters to all hospitals.

Not first ofence

This is the second time that Balaji hospital is being pulled up for defrauding patients. In 2016, it was de-empanelled after it was found to have overbilled 30 patients under the health insurance scheme.

Shinde expressed surprise at how the hospital managed to get empanelled again. “We’re looking into it, he said.

Dr Ramesh Kagzi, chairman of Balaji hospital, called the allegations a “conspiracy”. “We have documents to prove that we have never overcharged patients. We have only asked them to pay up for treatment not covered by the scheme. Someone is trying to malign our image,” he said. He claimed that in 2016, a “false case” was registered against the hospital and that it was empanelled again once its name was cleared.