Lok Sabha Question No. 1885 (UNSTARRED), answered on 2024-12-06
Subject: Unnecessary Surgeries under PMJAY
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Shri Sudama Prasad

## GOVERNMENTOFINDIA MINISTRYOF HEALTH AND FAMILYWELFARE DEPARTMENTOFHEALTH AND FAMILYWELFARE

## LOK SABHA UNSTARRED QUESTION NO. 1885 TO BE ANSWERED ON 06 TH DECEMBER, 2024

## UNNECESSARY SURGERIES UNDER PMJAY

## 1885. SHRI SUDAMAPRASAD:

Will the Minister of HEALTHAND FAMILYWELFARE be pleased to state:

(a) whether it is true that unnecessary surgeries (as reported in The Wire 16th November 2024 for the patients) are done by hospitals empanelled under the PMJAY-Ayushman Bharat Scheme, if so, the action taken/proposed to be taken by the Government against such hospitals;

(b) the details of complaints received against private hospitals and diagnostic centres empanelled under the Ayushman Bharat Scheme by patients for providing improper services since the inception of the scheme along with the action taken against these complaints;

(c) the total number of beneficiaries enrolled under Ayushman Bharat Schemes along with the list of beneficiaries having Ayushman Vay Vandana Card, State-wise; and

(d) the total amount sanctioned under the said scheme since its inception, State-wise?

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

(a) and (b): With regards to the case under reference, an FIR has been lodged on 12.11.2024 against the said hospital and the involved doctors. Further, the hospital and the implicated doctors have been suspended from the Ayushman Bharat -Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

As on 25.11.2024, a total of 18,184 grievances have been registered on the CGRMS, pertaining to issues such as denial of treatment, charges for admission, discharge or medicines and the unavailability of Pradhan Mantri Arogya Mitra (PMAM) etc.

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 de-empanelment of hospitals, de-activation of e-cards, levying penalty on errant hospitals and lodging of FIRs are taken against fraudulent entities.

Under AB-PMJAY, a three-tier grievance redressal system at District, State and National level has been created to resolve the issues faced by beneficiaries in utilizing healthcare. At each level, there is a dedicated nodal officer and Grievance Redressal Committees to address the grievances. Beneficiaries can file their grievance using different mediums including web-based portal Centralized Grievance Redressal Management System (CGRMS), Central & State call centers, email, letter to State Health Agencies etc. Based on the nature of grievance, necessary action for resolution is taken including coordination with the hospital and providing of support to the beneficiaries in availing treatment under the scheme.

- (c): AB-PMJAY aims to provide health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to approximately 55 crore beneficiaries corresponding to 12.37 crore families constituting economically vulnerable bottom 40% of India's population. As on 31.10.2024, a total of 35.8 crore Ayushman cards have been created under the scheme. State/UTwise details of number of Ayushman cards created under the scheme are at Annexure-I .

As on 02.12.2024, a total of 20.4 lakh Ayushman Vay Vandana cards have been created under the scheme. State/UT-wise details of Ayushman Vay Vandana cards created under the scheme are at Annexure-II .

- (d): Under AB-PMJAY, the central share is released to the States on the basis of actual utilization of the scheme by the beneficiaries, subject to a ceiling. There is no State-specific allocation or sanctioned amount. The details of funds allocated under AB-PMJAY since its inception are as under:

| Financial Year   |   Funds allocated for release to States/UTs as Grant-In-Aid (in crore of Rs.) |
|------------------|-------------------------------------------------------------------------------|
| 2018-19          |                                                                          2079 |
| 2019-20          |                                                                          5795 |
| 2020-21          |                                                                          5995 |
| 2021-22          |                                                                          5995 |
| 2022-23          |                                                                          6000 |
| 2023-24          |                                                                          6220 |
| 2024-25          |                                                                          6878 |

## State/UT-wise details of number of Ayushman cards created under the scheme

| State/UT                                 | Number of Ayushman cards created   |
|------------------------------------------|------------------------------------|
| Andaman And Nicobar Islands              | 72,939                             |
| Andhra Pradesh                           | 1,55,76,406                        |
| Arunachal Pradesh                        | 1,47,005                           |
| Assam                                    | 1,76,97,074                        |
| Bihar                                    | 3,56,39,789                        |
| Chandigarh                               | 2,13,794                           |
| Chhattisgarh                             | 2,27,26,145                        |
| Dadra And Nagar Haveli And Daman And Diu | 4,45,366                           |
| Goa                                      | 81,888                             |
| Gujarat                                  | 2,61,36,516                        |
| Haryana                                  | 1,21,76,689                        |
| Himachal Pradesh                         | 13,39,890                          |
| Jammu And Kashmir                        | 86,68,794                          |
| Jharkhand                                | 1,22,83,078                        |
| Karnataka                                | 1,75,35,705                        |
| Kerala                                   | 77,21,284                          |
| Ladakh                                   | 1,89,601                           |
| Lakshadweep                              | 36,996                             |
| Madhya Pradesh                           | 4,07,32,323                        |
| Maharashtra                              | 2,87,04,774                        |
| Manipur                                  | 6,53,206                           |
| Meghalaya                                | 20,09,470                          |
| Mizoram                                  | 5,66,253                           |
| Nagaland                                 | 7,40,084                           |
| Puducherry                               | 5,14,148                           |
| Punjab                                   | 89,61,752                          |
| Rajasthan                                | 2,23,43,366                        |
| Sikkim                                   | 78,616                             |
| Tamil Nadu                               | 75,33,010                          |
| Telangana                                | 82,49,233                          |
| Tripura                                  | 20,05,835                          |
| Uttar Pradesh                            | 5,13,36,525                        |
| Uttarakhand                              | 58,16,538                          |

## Annexure-II

## State/UT-wise details of Ayushman Vay Vandana cards created under the scheme

| State/UT                    |   Number of Ayushman Vay Vandana cards created |
|-----------------------------|------------------------------------------------|
| Andaman And Nicobar Islands |                                            160 |
| Andhra Pradesh              |                                           9756 |
| Arunachal Pradesh           |                                             13 |
| Assam                       |                                           5212 |
| Bihar                       |                                          60402 |
| Chandigarh                  |                                           5175 |
| Chhattisgarh                |                                          21371 |
| DNHandDD                    |                                            709 |
| Goa                         |                                           1484 |
| Gujarat                     |                                         201117 |
| Haryana                     |                                          60973 |
| Himachal Pradesh            |                                          11986 |
| Jammu And Kashmir           |                                            531 |
| Jharkhand                   |                                           4048 |
| Karnataka                   |                                          66050 |
| Kerala                      |                                         387135 |
| Ladakh                      |                                              5 |
| Lakshadweep                 |                                             27 |
| Madhya Pradesh              |                                         758756 |
| Maharashtra                 |                                          17829 |
| Manipur                     |                                           2884 |
| Meghalaya                   |                                             47 |
| Mizoram                     |                                             33 |
| Nagaland                    |                                             92 |
| Puducherry                  |                                           2947 |
| Punjab                      |                                          36518 |
| Rajasthan                   |                                          17547 |
| Sikkim                      |                                            551 |
| Tamil Nadu                  |                                          60548 |
| Telangana                   |                                           9574 |
| Tripura                     |                                            447 |
| Uttar Pradesh               |                                         297673 |
| Uttarakhand                 |                                           3210 |