ED found suspicious transactions of over Rs 21 crore involving claims for 23,000 patients
In a significant development, the Enforcement Directorate (ED) has expanded its investigation into fraudulent activities associated with health schemes in Himachal Pradesh, now targeting the HIMCARE Yojana after uncovering irregularities in the Ayushman Yojana. During recent raids, the ED seized claims and documents related to the Ayushman Bharat Yojana, HIMCARE, and other health schemes, highlighting widespread financial mismanagement.
Before the ED raids in the state’s private hospitals, the Himachal Pradesh government had already excluded private hospitals from the HIMCARE scheme during a recent cabinet meeting. This move comes in response to mounting evidence of fraudulent activities and discrepancies in the claims submitted by these hospitals.
From 2018 to 2024, the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana facilitated the treatment of 2,54,900 patients in Himachal Pradesh, with a total expenditure of Rs 322.16 crore, comprising Rs 105.93 crore from the state and Rs 216.23 crore from the center. Simultaneously, the Chief Minister HIMCARE Health Care Scheme treated 764,707 patients, incurring costs of Rs 987.79 crore. Despite these substantial expenditures, a liability of Rs 370 crore remains pending with the hospitals.
Seizure of Critical Documents and Digital Evidence
The ED’s investigation into the Ayushman scheme has revealed proceeds of crime amounting to approximately Rs 25 crore. On Wednesday, the ED conducted raids across 19 locations, including Delhi, Chandigarh, Punjab, and the Himachal Pradesh districts of Kangra, Una, Shimla, Mandi, and Kullu. The raids resulted in the seizure of cash, bank lockers and information related to 140 bank accounts.
During the recent raids, the ED seized immovable and movable properties, books of accounts, and other documents. Additionally, 16 digital devices, including mobile phones, iPads, hard disks and pen drives were confiscated. These devices contained crucial information about claims and transactions related to the Ayushman Bharat Yojana, HIMCARE, and other health schemes.
The seized documents revealed suspicious transactions worth Rs 21 crore involving claims for 23,000 patients. The investigation exposed significant discrepancies between the claims submitted to the government and the actual figures recorded in hospital files. Moreover, the ED discovered that many files related to patient claims had mysteriously disappeared.
The ED’s ongoing investigation continues to uncover extensive fraudulent activities within the health schemes. The discrepancies and irregularities in the claims process have raised serious concerns about the integrity of these programs. As the ED intensifies its probe, the state government and health department face increasing pressure to implement stricter oversight and accountability measures to prevent further abuse of public funds.
