State Government to Exclude Private Hospitals from HIMCARE Scheme Amid Fraud; Chief Minister Vows Reforms After Fraudulent Claims
In a significant development, the Enforcement Directorate (ED) is set to issue summons to those implicated in a massive fraud case involving crores of rupees through fake Ayushman cards. The ED’s interrogation is expected to uncover substantial revelations, with the fraud case involving crime proceeds estimated at around Rs 25 crore. The investigation will also scrutinize properties owned by the implicated hospitals.
On Wednesday, the ED conducted extensive raids at 20 locations across Delhi, Chandigarh, Punjab, and several districts in Himachal Pradesh, including Kangra, Una, Shimla, Mandi, and Kullu. These raids carried out under the provisions of the Prevention of Money Laundering Act (PMLA), 2002, resulted in the seizure of Rs 88 lakh in cash, four bank lockers, and 140 related bank accounts. Additionally, 16 digital devices such as mobile phones, iPads, hard disks, and pen drives, along with immovable and movable properties, books of accounts, and other documents, were confiscated.
The ED is examining the records obtained from the seized devices and bank accounts to uncover the extent of the illicit properties amassed by the accused. Beyond the Ayushman Scheme, the ED will also scrutinize records from the Himcare Yojana. During the raids, documents related to claims under the Ayushman Bharat Yojana, Himcare, and other health schemes were seized. These documents reveal suspicious transactions totalling Rs 21 crore for 23,000 patients, highlighting a significant discrepancy between the claims submitted to the government and the actual records maintained by the hospitals. Additionally, numerous claim files in patients’ names were found missing.
Despite the ongoing investigations, the state government and the health department will continue to process payments for treatments provided under the Himcare scheme up to August. However, these payments, amounting to approximately Rs 1,000 crore, will only be made after thorough investigations. Notably, Rs 550 crore is owed to the government hospitals, and Rs 450 crore to the private hospitals.
From September 1, private hospitals will be excluded from the Himcare scheme, although patients currently receiving treatment under this scheme need not worry. Presently, 147 private hospitals across the state provide treatments under the HIMCARE card. The state government is actively addressing the irregularities in the Himcare scheme.
Chief Minister Sukhvinder Singh Sukhu acknowledged that some private hospitals have significantly exploited the Himcare scheme. He cited instances where operations that should have cost around Rs 20,000 were billed at Rs 1 lakh. The Chief Minister’s remarks suggest that the state government may reassess all payments made under the Himcare scheme. Deputy Director Himcare Devendra Kumar confirmed that the Himcare facility will cease in private hospitals from September 1.
Chief Minister Sukhu pointed out that the scheme was launched hastily without adequate preparation, allowing private hospitals to take undue advantage. While the Himcare scheme will continue in government hospitals, the state aims to enhance its implementation.
