Ayushman Bharat scam
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Ayushman Bharat Beneficiaries Scammed


Bypassing Ayushman Bharat, doctor at top Central hospital duped patients, made killing on implants. Despite being beneficiaries of Ayushman Bharat, the patients were allegedly told that getting clearance would take months, while they needed surgery immediately. When asked whether they could purchase them from another source, they were told there would be an issue with the quality.
Neurosurgeon at Safdarjung Hospital in custody after he and his associates overcharged for implants, keeping patients in the dark about flagship scheme.
A lineman from Meerut, suffered an injury while at work. Though he is eligible under Ayushman Bharat, his family paid Rs 80,000 for an implant.
In March this year, when he suffered a fall while at work, his family had some comfort: they had the Ayushman Bharat scheme to pay for his treatment.
However, a visit to Safdarjung Hospital, one of the nation’s premier medical institutes run by the Central government, set them back by Rs 80,000 as they fell prey to a racket allegedly run by a neurosurgeon and his associates.
That surgeon, Dr Manish Rawat, Associate Professor at the Department of Neurosurgery, Safdarjung Hospital, is in judicial custody and the subject of a CBI probe.
This example has played out in several cases. An investigation, CBI court filings, and interviews with several doctors and patients indicates how 54 patients were allegedly duped in the first three months of this year; how Rs 2.7 crore was collected for implants from mostly poor families over two years, including during Covid; and a nexus of middlemen and companies was used to route the money, including three where Rawat’s wife was a stakeholder.
Ironically, many of these implants were covered under the Centre’s flagship Ayushman Bharat scheme. “Investigation has revealed that Dr Manish Rawat, in conspiracy… with others, did not allow the eligible patients to avail the benefits of Ayushman Bharat scheme of Government of India in order to take illegal money,” the chargesheet states.
This comes when the Centre’s flagship scheme covers an extensive network of over 27,000 empanelled hospitals. As of July 15, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana had recorded 5.37 crore authorized hospital admissions.
One of the most notable aspects of the scheme is that 57 per cent of the empanelled hospitals, which provide free treatment to beneficiaries, are public hospitals. This enables poor patients to confidently seek treatment with the faith that they will not be cheated of their dues.

What is Ayushaman Bharat?
Ayushman Bharat is the Pradhan Mantri Jan Arogya Yojna or PM-JAY
• It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals in India. Hospitals must meet specific criteria and standards to be eligible for empanelment.
• There is no enrollment fee or premium charged to the beneficiaries to avail themselves of the benefits of the scheme.
• All pre–existing conditions are covered from day one.
• Over 12 crore poor and vulnerable entitled families (approximately 55 crore beneficiaries) are eligible for these benefits, based on Socio-Economic Caste Census of 2011.
• It provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
• It envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year.
• It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
• There is no restriction on family size, age or gender. Moreover children, women and senior citizens are held in special regard.
• Benefits of the scheme are portable across the country i.e., a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment, making it easier for migrant workers and families.
• Services include approximately 1,929 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
• Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
• It is the world’s largest health insurance/ assurance scheme fully financed by the government.

What’s the scam?
However, this case serves as a reminder of loopholes in the system.
In its chargesheet, the CBI looked at payments made by 94 patients in the first three months of this year and gathered data of 54 being overcharged.
A detailed analysis of patient data reveals glaring discrepancies between the actual cost of the implants and the amount allegedly charged to patients by Dr Rawat and his associates. In as many as 25 cases, the money allegedly received for implants was as much as 500% of the actual cost charged by the seller.

Examples:

  • On an average, patients paid Rs 48,833 for a medical implant, while the sellers received an average payment of Rs 11,604.
  • Some cases are stark: One patient paid Rs 60,000 for an implant, while the seller got Rs 2,000; two other patients paid Rs 50,000 and Rs 49,000, while the corresponding payments to the seller were Rs 4,000 each; and in yet another case, the seller got Rs 2,000 while the patient had paid Rs 35,000 for an implant.
  • In seven cases, the patient paid over Rs 1 lakh, resulting in an average overcharging of more than Rs 90,000. The highest amount charged from a patient was Rs 1.66 lakh, while the seller in this case got Rs 58,000.

The CBI has pointed to a series of transactions directed towards three entities in particular: Jubilation Bio Science Pvt Ltd, Jubilation Business Services Pvt Ltd, and A&A Enterprises. Dr Rawat’s wife is a stakeholder in all three firms.
The CBI has alleged that Dr Rawat, with the help of Avnesh Kumar Arya and one Manish Sharma, also a former employee of Jubilation Bio Science Pvt Ltd and another accused in the case, collected approximately Rs 2.7 crore from patients between February 26, 2021, and March 29, 2023.
The CBI charge-sheet also details how relatives of patients were allegedly put in a spot by Dr Rawat’s accomplices, particularly in times of desperation.

Two Notable Cases:
A patient who came in suffering from tuberculosis meningitis and doctors began treating a build-up of fluid in cavities deep within the brain. He was admitted under the care of Dr Rawat on 7th March.
According to the CBI, when his health deteriorated, it was decided to insert an external ventricular device (EVD) in the ventricle to drain the fluid and release pressure in the brain.
The CBI chargesheet states that despite shunts and EVD kits being readily available in the department of neurology free of cost for patients, his relatives were kept in the dark.
Instead, the CBI alleges, Arya and Sharma, who were already present in the OPD room, informed his son that his father needed an operation to implant a “shunt” in his brain. They demanded Rs 50,000 to cover the cost.
On March 8, his condition worsened, and he succumbed to his illness. “Investigation has revealed that Rawat in connivance and conspiracy with Arya and Sharma performed his public duty dishonestly in consequence of accepting an undue advantage from the patient and abused his official position as a public servant,” the CBI chargesheet states.

On March 7, another patient was brought to the casualty department before being referred to the department of neurosurgery under Dr Rawat’s care. An early spine operation was suggested and on March 10, 2023, a lateral mass and rod fixation procedure was performed.
According to the chargesheet, Dr Rawat introduced Arya as his personal assistant to the patient’s family. Arya proceeded to explain the availability of three different implants in the market – costing between Rs 50,000 and Rs 1 lakh, plus GST if they needed a bill.

The family eventually opted for the most expensive implant, paying Rs 1,15,500. However, the CBI has stated that the actual cost of the implant was only Rs 14,000.

Dr Rawat joined Vardhman Mahavir College and Safdarjung Hospital as an assistant professor in the Department of Neurology in June 2016. He was promoted to the position of associate professor by the Union Health Ministry in November 2022. Prior to his tenure at the college and hospital, Dr Rawat had been practising at various private hospitals in Bareilly. According to investigators, it is in Bareilly that Dr Rawat met Arya in 2014.

Safdarjung Hospital, where the alleged crimes took place, is a prominent and bustling tertiary-level, multidisciplinary healthcare institute operated by the Centre. Recognized for its scale and capacity, it serves a substantial population of underprivileged and marginalized individuals, addressing their critical healthcare requirements.

While operations at Safdarjung Hospital are free of charge, patients undergoing neurosurgery procedures are responsible for procuring any cranial or spinal implants required for their treatment. However, individuals covered under the Ayushman Bharat Scheme are eligible to have the costs of these implants fully covered. The emergency department of the hospital is among the busiest sections, witnessing a footfall of more than 1,000 patients every day.

The CBI has alleged that Dr Rawat instructed senior residents to compile a list of patients admitted to the emergency ward. Following this, his two associates would impersonate personal assistants and inform patients that surgical implants needed to be obtained externally. It is also alleged that Dr Rawat used to provide slips to patient attendants in the neurosurgery OPD. These slips allowed them to get in touch with his associates in order to arrange implants from the outside, the CBI has alleged.

As per the updates, just days after Dr Rawat’s arrest, a three-member technical committee was formed by the then Medical Superintendent with the purpose of investigating the procurement of implants from external sources for surgeries. The committee’s objective, is to address situations where these implants were not readily available within the hospital and to assist patients in obtaining them at a reasonable cost.

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