Final decision over health fraud vests with states

The CAG's performance audit report, tabled in the Lok Sabha recently, revealed multiple cases under the scheme, providing treatment for patients who had already been declared dead, as well as for thousands of people using the same Aadhaar number or invalid mobile phone number. However, the Health Ministry defended the scheme, saying that mobile numbers did not play any role in the verification of scheme beneficiaries.

The National Health Authority (NHA), implementing agency for ABPMJAY, while accepting the audit observation, stated that the National Anti-Fraud Unit (NAFU) had sent periodic reminders to the states/UTs highlighting discrepancies in verified data.

"However, 'public health' being a state subject, the final decision in this regard vests with the state governments. Also, NHA is developing a policy to disable 'Add Member' functionality in case of any beneficiary family with more than 15 members," NHA said.

Further, it added, NAFU is sending a communication to the states/Union territories to fully audit all such cases where family size is above a certain threshold.

Regarding errors in linking of Aadhaar in Tamil Nadu, NHA replied that the state is using its own IT platform (and database) for beneficiary identification. NHA has urged states to migrate to the Aadhaar based BIS platform of NHA to strengthen beneficiary verification protocols, according to the CAG report.

In 7.5 lakh cases, the beneficiaries were found to be linked with the same mobile number, 9999999999, which was invalid. Health ministry sources claimed this may have been possible because initially, the mobile number was not a mandatory field during beneficiary verification. "However, since there was a field for mobile numbers, it is possible a random 10-digit number was entered by the field-level workers," one of the sources said.

Other irregularities pointed out include treatment of a beneficiary already shown as 'died' during earlier claim, admission of the same patient in multiple hospitals during the same hospitalisation period, and number of patients admitted to a hospital exceeding its declared bed strength.