SRINAGAR, AUGUST 05: Jammu and Kashmir has cracked the whip against private hospitals and nursing homes for submitting fraudulent claims seeking inflated reimbursements under the AB-PMJAY-SEHAT insurance scheme.
State Health Agency (SHA) suspended the empanelment of Hakeem Sanaullah Hospital, Sopore, and imposed a penalty of Rs. 5.81 lakhs and Rs. 4.98 Lakhs on Mohammadia Nursing Home, Pulwama, and Florence Hospital, Srinagar respectively, for various fraudulent activities.
The action against these health care institutions was mainly taken for non-adherence to minimum criteria for empanelment, non-maintenance of quality service standards as laid under the AB-PMJAY-SEHAT scheme, and illegal reimbursements.
Earlier, SHA J&K took similar kind of action against Ibn Sena Hospital, Budgam, Quality Healthcare Hospital, Kupwara, Ess Bee Hospital, Kupwara, North Kashmir Hospital, Handwara, Waseem Memorial Hospital, Handwara, and Narayana Hrudayalaya hospital Katra and imposed a total penalty of Rs. 44.6 Lakhs on these errant hospitals.
The government said fraud under AB-PMJAY-SEHAT not only results in financial losses but have a much greater impact on people’s health.
AB-PMJAY-SEHAT aims to develop an anti-fraud culture that permeates all aspects of the scheme’s governance. The approach to anti-fraud efforts is based on principles like Transparency, Accountability, Responsibility, Independence, and Reasonability.
Recently, in a review meeting of ABPMJAY-SEHAT, Principal Secretary Health & Medical Education, Manoj Kumar Diwedi said the government has adopted a zero-tolerance approach while dealing with the instances of fraud and abuse under the ABPMJAY-SEHAT scheme. He said strict action will be taken against the hospitals and doctors involved in any kind of errant or fraudulent activities under the scheme.