Ayushman Bharat Scheme fraud: ED raids hospitals across four states and UTs

Shimla, Aug (IANS) The Enforcement Directorate (ED) has conducted searches at 20 locations across Delhi, Chandigarh, Punjab, and Himachal Pradesh in connection with a case involving the alleged creation of fake Ayushman Bharat AB-PMJAY ID cards and violations of the scheme by several hospitals. 

These actions were carried out under the Prevention of Money Laundering Act (PMLA), 2002.

In Himachal Pradesh, the searches were carried out in the districts of Kangra, Una, Shimla, Mandi, and Kullu. According to an ED press release, the searches were conducted against Shree Banke Bihari Hospital, Fortis Hospital Himachal Healthcare Private Ltd, City Super Specialty Hospital, Shri Balaji Hospital, Shri Harihar Hospital, Sood Nursing Home, Neelkanth Hospital and their key management persons Dr Vijender Minhas, Raghubir Singh Bali, Dr Pradeep Makkar, Dr Rajesh Sharma, Manish Bhatia, Dr Manoj Sood, and Dr Hemant Kumar, respectively.

The ED initiated the investigation on the basis of an FIR registered by the State Vigilance & Anti-Corruption Bureau (SV & ACB), Una under various sections of the IPC, 1860 against Kiran Soni, Shree Banke Bihari Hospital, Una and others for generating fake AB-PMJAY ID cards.

The ED investigation revealed that apart from Bankey Bihari Hospital, Shri Balaji Hospital, Sood Nursing Home, Fortis Hospital, and Sri Harihar Hospital etc. availed benefits of the AB-PMJAY scheme. During the investigation, as many as 373 fake Ayushman Cards have been identified wherein claims of about Rs 40.68 lakh (approx) were made for reimbursement from the government in the name of treatments given to the said Ayushman Card beneficiaries, the ED release said.

The list of such fake beneficiaries included the names of Rajnish Kumar (ABPMJAY Card No. PPKZU26H7) and Pooja Dhiman (ABPMJAY Card No. PICHWGI08), who on verification, even denied possession or any information of any such PMJAY Card.

The ED says that "they never underwent any such treatment in any of these hospitals. Apart from this, hospitals have made claims for treatments/surgery/admission which were actually never given/done to the patient".

"Raksha Devi (having PMJAY ID- PLOE81RR2Q) was denied admission in the hospital, however, the hospital dishonestly and illegally blocked the package of Raksha Devi. The investigation also revealed that these hospitals were de-empanelled from the Ayushman Bharat scheme for illegal practices and non-compliance with procedures/guidelines. 8937 Ayushman Bharat golden cards have so far been scrapped in HP for alleged violation of the AB-PMJAY scheme. As per investigation conducted so far, the case involves Proceeds of Crime (PoC) of about Rs 25 crore."

According to the press release, ED searches led to the discovery of cash of Rs 88 lakh (approx), four bank lockers, and 140 related bank accounts. Further, apart from immovable and movable properties, books of accounts and other documents, 16 digital devices in the form of mobile phones/ iPads, hard disks, and pen drives containing information regarding claims and documents related to AB-PMJAY, Himcare and other health schemes were found and seized.

The seized documents contain information about claims of the hospitals and included suspicious transactions worth Rs 21 crore for 23,000 patients. Searches also revealed several cases having severe mismatches in claims made to Govt. and actual data and data available in files in the hospital. It was also observed that several files regarding claims in the names of patients have gone missing.