Ayushman Bharat Yojana: Highest claims of this same surgery from private hospitals of many states, NHA surgeons

Health insurance of 5 lakhs is available free under Ayushman Bharat scheme. However, the NHA’s ears have cropped up due to numerous claims of the same surgery from private hospitals in many states.

New Delhi: Under the Ayushman Bharat scheme, poor people are getting health insurance up to Rs 5 lakh free. Under this, up to Rs 5 lakh insurance is provided for the treatment in the registered hospital under the scheme.

However, the National Health Authority has found strange things in the claims figures received under the scheme. Under the Pradhan Mantri Jan Arogya Yojana, 6 states have received the most claims from hysterectomy. All these cases are of private hospital.

It is the NHA that is implementing the Pradhan Mantri Jan Arogya Yojana in the country. The agency is investigating such claims. The authority has also commissioned a working paper on it.

This paper has been prepared for the analysis of this scheme. With this, the trend of the scheme is being reviewed. A government official told ET that hysterectomy has traditionally been the source of misuse of insurance in the private sector. If this is done in a wrong way, then the woman can be at a disadvantage. It is a matter of people’s health.

1 per cent of the total claims from 24 states are associated with this surgery, while it accounts for 2 per cent of the total claims of women. Chhattisgarh (21.2 per cent), Uttar Pradesh (18.9 per cent), Jharkhand (12.2 per cent), Gujarat (10.8 per cent), Maharashtra (9 per cent), Karnataka (6.6 per cent) 6 states have made the highest claims under the scheme. Of this, 75 percent of claims are of hysterectomy.

Chhattisgarh and Uttar Pradesh have the highest claims from the private sector. Ayushman from Uttar Pradesh accounts for 5% of the total claims in India. Out of which 18.9 percent claims are of hyserectomy.

From Chhattisgarh, he has come under a hysserectomy. 94.5% of claims came from private hospitals. This is a matter of concern. The report also calls for closer scrutiny of claims from Haryana, Jharkhand and Arunachal Pradesh. 

According to experts, this surgery is done in many states for family planning. Many women have their uterus removed so that they can work in the fields. Overall, the National Health Authority is monitoring all types of claims.

Many private hospitals in Mediclaim Insurance do this kind of fraud. After this, insurance companies blacklist such hospitals. Some of the city’s private hospitals are notorious in this case. Claims from there are thoroughly investigated.

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