Four more hospitals in the state have taken action under the State Anti-Fraud Unit (SAFU) drive against alleged irregularities in hospitals listed under the Pradhan Mantri Jan Arogya Yojana-Mukhya Mantri Amrutam (PMJAY-MA) scheme, the National One Hybrid. have faced Ayushman Bharat and Health Insurance Scheme under Gujarat Govt.
Along with this, the number of hospitals under the campaign has reached 16 this financial year.
The latest hospitals to face action are Krishna Surgical Hospital and Swastik Multispeciality Hospital, both in Rajkot; Jaiben Modi Hospital in Bharuch; and Bankers Super Specialty Hospital in Vadodara.
The Gujarat government began cracking down on alleged irregularities in the Ayushman Bharat scheme in light of two major rackets that came to light this year: the admission of healthy newborns to an affiliated Babycare Children’s Hospital in Rajkot and the death of two men after allegedly unnecessary angioplasty operations. At a reputed multispeciality hospital in Ahmedabad.
Both cases stemmed from tampering with patients and false claims based on falsified medical records, officials said.
Meanwhile, the health department said the state government has prepared new guidelines (SOPs) for treatment under the scheme, including cardiology and cardiovascular surgery, radiotherapy and newborn care, which will be announced soon.
On Tuesday, a statement from the health department said SAFU along with a team of expert doctors visited hospitals suspected of irregularities under the scheme in the state.
Swastik Multispeciality Hospital, Rajkot
Swastik Multispeciality Hospital in Rajkot was audited by a listed insurance company as part of the scheme. The insurer was found to have tampered with USG (ultrasound sonography) plates and HPE (histopathological examination) reports in a total of 196 cases.
The hospital has been suspended from the scheme and other hospitals associated with the facility will also be prosecuted. Also, according to the scheme guidelines, the hospital has been fined Rs 2.94 crore.
Gynecologist Dr. Rajesh Kandoria of the hospital has been blacklisted by the scheme.
Krishna Surgical Hospital, Rajkot
In this hospital in Upleta, rural Rajkot, Safu found many problems including infrastructure, manpower and sanitation. Not only did the hospital’s building use (BU) certificate and fire safety certificate (FSC) lapse, it also lacked a certificate from the Atomic Energy Regulatory Board (AERB) that is required for installing X-ray equipment in hospitals. the hospital
Besides, the hospital was found to lack manpower as prescribed by the scheme, officials said, adding that there were problems with infection prevention and control (IPC) measures in the intensive care unit (ICU).
Inconsistencies were found in the information given by the doctor in the OT note and anesthesia note. So the hospital has been suspended from the scheme until these deficiencies are rectified, officials said.
Jaiben Modi Hospital, Bharuch
Safu has shown that the staff of this hospital uploaded the Tumor Board Certificate (TBC) in the software and tampered with the officer’s signature and ticket. As a result, the hospital’s pre-authorization claims of Rs 33.44 lakh will be refunded by the State Health Agency (SHA). The punishment will be decided in the upcoming SGRC (State Grievance Redressal Committee).
Bankers Superspeciality Hospital, Vadodara
Officials investigating this hospital in Vadodara found violations of Ayushman Bharat Yojana guidelines in oncology surgery packages. The hospital’s pre-authorization claim of Rs 57.51 lakh will be recovered by the SH and the fine will be decided in the next meeting of the SGRC.
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