Madhya Pradesh: 7 more hospitals lose licence for Ayushman Bharat scam – ET HealthWorld

Bhopal: The licences of seven more private hospitals have been terminated and two hospital owners face criminal action after investigation into a multi-city scam unearthed fraudulent mediclaims under Ayushman Bharat scheme in Madhya Pradesh.

Seven of these private hospitals are in Bhopal. Owners of five of them face stiff penalties and the possibility of losing their medical practitioner license. Eight other hospitals in the state capital are yet to respond to the notices from the health department.

In all, 28 empanelled hospitals in MP were issued notices last month. Legal action has been taken against nine after they replied to notices, said Ayushman Bharat ‘Niramayam’ CEO Anurag Chaudhary. It is not just confirmation calls that blew the lid on the scam. “We used machine learning and artificial intelligence to generate triggers. These patient cases are then investigated,” said Chaudhary. “In most cases, the payment has not been paid to the private hospitals. Recoveries will be made and some doctors may lose their right to remain medical practitioners,” he added.

One recovery from a Bhopal-based private hospital amounts to Rs 4.5 crore, according to an FIR filed on Tuesday.

Estimates place the scam amount figure close to 2%-3% of about Rs 5,000 crore annual corpus for Ayushman Bharat in MP. Sources say 518 private hospitals are empanelled to offer government insurance up to Rs 5 lakh per family per year, and 47 of them have been assessed.