Lok Sabha Question No. 3052 (UNSTARRED), answered on 2024-12-13
Subject: Monitoring of Empanelled  Hospitals
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Shri Murari Lal Meena

## GOVERNMENTOFINDIA MINISTRYOF HEALTH AND FAMILYWELFARE DEPARTMENTOFHEALTH AND FAMILYWELFARE

## LOK SABHA UNSTARRED QUESTION NO. 3052 TO BE ANSWERED ON 13 TH DECEMBER, 2024

## MONITORING OF EMPANELLED HOSPITALS

## 3052. SHRI MURARI LALMEENA:

Will the Minister of HEALTHAND FAMILYWELFARE be pleased to state:

- (a) whether the Government is aware of the instances of deaths taking place due to unnecessary angioplasty, surgeries of patients in reputed hospitals, if so, the details thereof;
- (b) the number of cases of fraud/unnecessary surgeries in hospitals empanelled under Ayushman Bharat Yojana;
- (c) whether the Government is likely to review the monitoring mechanism in place for hospitals empanelled under the said yojana, if so, the details thereof along with the action taken to prevent fraudulent practices in this regard; and
- (d) whether the Government proposes to de-empanel the hospitals that have been found guilty of committing fraudulent activities under the said yojana and register cases against them under serious sections to ensure priority of interests of the patients in the future and if so, the details thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI PRATAPRAO JADHAV)

- (a) and (b): Suitable penal actions are initiated in cases of reported instances of deaths due to unnecessary angioplasty and surgeries in reputed hospitals. Additionally, the implicated hospitals and doctors have been suspended from the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

As on 11.12.2024, a total of 3,42,988 fraud cases have been identified under AB-PMJAY. Out of these, 2,86,771 cases are of medical management and 56,217 cases are of surgical management category.

(c) and (d): AB-PMJAY ensures quality healthcare services to the scheme beneficiaries. The scheme is governed on a zero-tolerance approach to any kind of fraud and abuse and various steps are taken for prevention, detection and deterrence of different kinds of fraud that could occur in the scheme at different stages of its implementation. National Anti-Fraud Unit (NAFU) has been established at National Health Authority (NHA) and works in close coordination with State Anti-Fraud Units (SAFU) to investigate and take joint action against issues related to fraud and abuse. Appropriate actions including suspension, show cause notice, warning letter, deempanelment of hospitals, de-activation of e-cards, levying penalty on errant hospitals and lodging of FIRs are taken against fraudulent entities.

Transaction data on NHA IT system is monitored on real-time basis through a dedicated dashboard known as Risk Assessment Detection and Analytical Reporting (RADAR). Further, a Fraud Control Tracking System (FACTS) has been developed under the scheme for a 360-degree view of fraud control, from reporting to tracking actions taken on suspicious transactions. Multiple avenues have been created for reporting fraud and abuse by Empaneled Healthcare Providers (EHCPs).

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