VB busts fake insurance reimbursement scam

Chandigarh: Punjab vigilance bureau busted scam worth crores of rupees under Ayushman Bharat scheme in which private hospitals obtained health insurance claims from an insurance company by submitting fake bills for treatment of beneficiary patients possessing smart health cards.

The insurance company, on the other hand, rejected hundreds of insurance claims pertaining to government hospitals, causing a huge loss to the state exchequer.

DGP-cum-chief director vigilance bureau, B K Uppal said it has come to fore that several well-known private hospitals based in Jalandhar, Hoshiarpur and Kapurthala districts had prepared hefty fake bills in the names of smart card holders for their treatment under Ayushman Bharat scheme and took insurance claims from IFFCO TOKIO. “A regular vigilance enquiry has been registered by the bureau to investigate this scam worth crores of rupees in the state,” he added.

Giving details of the preliminary findings, Uppal said senior superintendent of police (SSP) vigilance range Jalandhar, Daljinder Singh Dhillon unearthed the fraud in which several fake medical bills of private hospitals had been cleared by the insurance company even as reimbursement bills forwarded by government hospitals were rejected. In this connection, major negligence has been seen at the end of concerned deputy medical commissioners and doctors of state hospitals/primary health centres. “The biggest reason for rejecting the insurance claims of government hospitals by the company was to get financial benefits. As a result, the Punjab government has incurred financial loss to the state exchequer in the last one year from three districts,” said Uppal.

It has come to light that a known hospital of Sultanpur Lodhi town in Kapurthala district had claimed Rs 4.43 crore for the treatment of about 1,282 patients and out of which 519 claims were rejected. On the basis of these medical bills, state health authority, Punjab passed claims of the hospital to the tune of Rs. 4.23 crore.

Source: The Times of India