NEW DELHI The database of India’s public health assurance scheme, the world’s largest, has several discrepancies that led to crores of rupees in expenditure on ineligible beneficiaries, mainly due to inadequate validation controls, a performance audit by the Comptroller and Auditor General has found.
The faults in the database of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) include invalid names, unrealistic dates of birth, duplicate health IDs and unrealistic family sizes, the government’s auditor said in a report tabled in Parliament on Tuesday.
“In the absence of adequate validation controls, errors were noticed in beneficiary database… In 36 cases, two registrations were made against 18 Aadhaar numbers and in Tamil Nadu, 4,761 registrations were made against seven Aadhaar numbers,” the report said. “Registration of multiple beneficiaries against same or invalid mobile number ranging from 11 to 7,49,820 beneficiaries were noted in the Beneficiary Identification System (BIS).”
For instance, between 2018 to 2021, 16,865 and 335 ineligible beneficiaries, respectively, were identified by health authorities in Jammu & Kashmir and Ladakh, after cleaning data of the Socio Economic and Caste Census, it said.
In six states and Union territories, ineligible households were found registered as PMJAY beneficiaries and had availed the benefits of the health scheme. “The expenditure on these ineligible beneficiaries ranged from ₹0.12 lakh in Chandigarh to ₹22.44 crore in Tamil Nadu,” the auditor said after scrutinising data for the period between September 2018 and March 2021.
The report was tabled on a day when junior health minister SP Singh Baghel in a written reply to Rajya Sabha said that the Indian government uses artificial intelligence and machine learning technologies to detect suspicious transactions and potential frauds under AB-PMJAY.
“These technologies are used for prevention, detection and deterrence of health care frauds in the scheme’s implementation and are helpful in ensuring appropriate treatment to the eligible beneficiaries,” Baghel replied to a question raised by the BJP’s Neeraj Shekhar and the Janata Dal (United)’s Ram Nath Thakur.
The central government’s flagship public insurance scheme was launched on September 23, 2018, to achieve universal health coverage, as recommended in the National Health Policy of 2017.
The scheme was rolled out in rural and urban areas based on deprivation and occupational criteria of the SECC 2011 for at least 107.4 million families, or about 500 million people, with an aim to “reduce out-of-pocket expenditure of the poor and vulnerable population.”
The report pointed out large gaps in hospital empanelment and management, with several states showing shortage of infrastructure, equipment, doctors and non-functional equipment. Some of the Empanelled Health Care Providers (EHCPs) neither fulfilled minimum criteria of support system and infrastructure, nor conformed to the quality standards and criteria prescribed under the guidelines, the CAG found.
In several states, mandatory compliances criteria for empanelment of hospitals relating to infrastructure, fire safety measures, biomedical waste management, pollution control and hospital registration certificate were not fully followed, the report said.
In some health care providers, fire safety certificates had expired before empanelment under PMJAY, it said. Also, some of the hospitals did not conform to the prescribed quality standards and criteria, which were crucial to the safety and well-being of beneficiaries and were mandatory minimum conditions for empanelment.
In addition, the availability of hospitals per lakh beneficiaries was low, ranging from 1.8 in Bihar to 26.6 hospitals in Goa. Among others, Assam had 3.4, Dadra Nagar Haveli-Daman Diu 3.6, Maharashtra 3, Rajasthan 3.8 and Uttar Pradesh had 5.
In Jharkhand, two private hospitals were not providing three specialities under the scheme, which were otherwise available for the general public. In Assam, 13 hospitals were providing 4% to 80% of available facilities to the beneficiaries, the auditor found.
The CAG report mentioned that the implementation of the scheme needs improvement in the light of the findings. “It is expected that the compliance to the observations and recommendations made in this report will help in improving the implementation of the scheme,” it said.