Mumbai: Maharashtra Police have registered a criminal case against the founders of three private hospitals in Nashik over an alleged ₹1.79 crore fraud involving two government-funded health insurance schemes. Investigators allege that the hospitals submitted 361 fraudulent treatment claims under the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) in an attempt to obtain government funds illegally. The FIR was registered at Worli Police Station following a state government inquiry into suspicious insurance claims.
According to the police, the FIR was filed on a complaint lodged by Chandrakant Vibhute, Deputy Secretary in the State Public Health Department. The complaint followed an investigation ordered by the Chief Minister into suspicious claims processed through the State Health Assurance Society. The inquiry was initiated to verify the authenticity of treatment records and payments made under the government health insurance schemes.
The FIR names Trilok Patil and Rahul Patil of Shiv Multi-speciality and Criticare Hospital, Rahul Patil and Vitthal Patil of Grace Hospital, and Prashant Jadhav and Preetam Pachpute of Hrishikesh Hospital as accused. Police allege that Shiv Multi-speciality and Criticare Hospital submitted 163 suspicious claims worth approximately ₹71 lakh, Grace Hospital filed 126 claims valued at around ₹62 lakh, and Hrishikesh Hospital submitted 72 claims amounting to nearly ₹45 lakh. The combined value of the alleged fraudulent claims stands at approximately ₹1.79 crore.
During the investigation, the Maharashtra government ordered a special review of 15,407 health insurance claims submitted through the online portal between July 2024 and February 2026. Officials said the audit was initiated after multiple claims were found to have been linked to the same mobile numbers, with several beneficiaries allegedly claiming more than ₹5 lakh within a single year. District Civil Surgeons and Health Officers were subsequently directed to carry out physical verification of beneficiaries and treatment records.
Police said that in Nashik district, 4,200 beneficiaries were physically verified out of 9,242 claims submitted under the two government schemes. The verification exercise identified 389 suspicious claims. However, due to incomplete records in 28 cases, criminal proceedings were initiated only in the remaining 361 cases where investigators said sufficient material was available to register an FIR.
The preliminary inquiry allegedly found that several claims contained incorrect or unverifiable beneficiary details, including invalid mobile numbers and inaccurate identification information. Investigators further alleged that some treatment claims had been submitted in the names of individuals who had already died. In certain instances, claims were allegedly raised after the beneficiaries’ deaths, prompting authorities to conduct a more detailed examination of the records and payment trail.
The case has been registered under relevant provisions of the Bharatiya Nyaya Sanhita (BNS) relating to criminal breach of trust, cheating, forgery, forgery of valuable security, and using forged documents as genuine. Investigators are examining hospital treatment records, patient documentation, digital claim data, payment records and the role of all individuals connected with the submission and processing of the disputed claims.
Officials said every suspicious claim will be examined individually to determine whether the alleged fraud was part of a larger organised scheme. If additional irregularities are uncovered during the investigation, more accused could be added to the case. Police stated that further legal action will be based on documentary evidence, digital records, beneficiary verification and the findings of the ongoing investigation.
About the author — Suvedita Nath is a science student with a growing interest in cybercrime and digital safety. She writes on online activity, cyber threats, and technology-driven risks. Her work focuses on clarity, accuracy, and public awareness.
