Cyber Crime
Hospital Owners Involved in Ayushman Health Insurance Fraud to Face Jail Time and License Cancellation of Hospital
Hospitals committing fraud under the Ayushman Scheme, operated by the State Health Authority, will now face strict action. On this issue, the Chairman of the Authority, Mr. Arvind Singh Hyanki, has issued firm instructions to the State Anti-Fraud Unit to remain vigilant.
In a review meeting held recently, Chairman Hyanki directed the State Anti-Fraud Unit to stay alert. He also instructed that audits should be conducted with greater caution and quality. Special audits are to be conducted before and after beneficiaries receive treatment under the Ayushman scheme. The unit will collect feedback from beneficiaries, particularly regarding claims rejected by the team, especially related to hospitals’ monetary demands. There will also be periodic checks to ensure that beneficiaries are receiving cashless and quality treatment at hospitals.
To avoid discrepancies in beneficiary details, all hospitals are now required to fill out detailed and accurate information about the beneficiaries in the declaration form. Mr. Hyanki emphasized the need to train call center employees, as this will assist in prompt investigations. If fraud is detected during the investigation, strict action will be taken against the involved hospital according to the guidelines issued by the National Health Authority.
Dr. Vinod Tolia, Director of Medical Quality, stated that actions are being implemented as per the issued directives. Investigation teams have been instructed to remain more vigilant and active.