Ayushman Bharat PMJAY “Modi-Care” Scam: 7.5 lakh people got linked to a single invalid phone number

On August 7th, a report submitted by the Comptroller and Auditor General (CAG) of India shed light on the hazardous discrepancies and scams getting executed under the Centre’s flagship scheme, Ayushman Bharat: Pradhan Mantri Jan Arogya Yojna (AB-PMJAY). 

In its report submitted before the Rajya Sabha, the CAG divulged that nearly 7.5 lakh beneficiaries of the AB-PMJAY (or “Modi-care”) got linked with a bogus phone number reading: 9999999999. 

Surprisingly, it cannot get brushed aside as a technical glitch because the system features as many as 139 thousand linked with the mobile number 8888888888, and over 96 thousand beneficiaries got registered under the number 9000000000. 

The report also illustrates how the ‘impeccable’ Aadhar numbers got misused in the entire debacle. Eighteen Aadhar numbers were associated with two registrations each in 36 instances. All these errors are too obvious to be the mischief of a few but a systemised scam.

As a response to this scandalous revelation, the Minister of State in the Ministry of Health and Family Welfare: Satya Pal Singh Baghel, tried to soothe the upper house by citing that the Modi government has been employing the newest technologies like artificial intelligence (AI) and machine learning (ML) to identify potentially fraudulent transactions within the AB-PMJAY scheme and cease such discrepancies.

What are the other hitches in the PMJAY scheme?

In its report, the CAG identified numerous problems associated with PMJAY. The CAG revealed several instances where healthcare providers kept providing treatments for previously deceased beneficiaries! 

The report read, “During desk audit (July 2020) audit had earlier reported to NHA that the IT system (TMS) was allowing the pre-authorisation request of the patient who was earlier shown as ‘dead’ during her/his treatment availed under the scheme.”

There were also confusing records of how one patient got admitted to various hospitals during the same period of hospitalisation! 

“Data analysis during desk audit (July 2020) revealed that the IT system (TMS) did not prevent any patient from getting admission in multiple hospitals during the same period of hospitalisations…data analysis revealed that 78,396 claims of 48,387 patients got initiated in TMS where the date of discharge of these patients for earlier treatment was later than admission date for another treatment of the same patient,” revealed the report.

The Audit report uncovered that the discrepancies under PMJAY reflected flaws comprising invalid names, forged health IDs, fallacious entries in the gender column, absurd family sizes, and implausible DoBs. 

The report exposed some of the empanelled healthcare providers (EHCPs) by revealing how they were suboptimal in the availability of doctors, infrastructure, and other crucial equipment. Some had perceivable inefficiencies in the fundamental aspects of fire safety parameters, bio-medical waste management, pollution control, and even the validity of hospital registration certificates.

What is the AB-PMJAY scheme?

On September 23rd, 2018, Prime Minister Narendra Modi launched the AB-PMJAY scheme with a leviathan budget of INR 10 thousand crores, dedicated to providing health insurance of INR 5 lakh per year to each family lacking financial stability (based on data from Census 2011).

The PMJAY was the outcome of merging the Rashtriya Swasthya Bima Yojana, launched in 2008 by the former PM Manmohan Singh to provide insurance worth INR 30 thousand per annum (at a premium of INR 30 per month) to the yellow card holding BPL families, with the Senior Citizens Health Insurance scheme of 2016.

The resultant PMJAY scheme covered a significant percentage of Indian demography:

• The AB-PMJAY aspires to connect 50 crore Indians under the scheme who belong to the bottom 40% of India’s economic demography;

• Today, 10.74 crore Indians are the beneficiaries of the scheme;

• Over 24 thousand hospitals (both public and private) get covered under the PMJAY;

• The scheme offers comprehensive support related to over 1300 medical packages.

Given the expanse of this extensive scheme, the truth is far from what gets promised. As per the recommendation of the World Health Organisation (WHO), each country should invest at least 5% of its GDP toward its health infrastructure. 

Under the Manmohan Singh Government, India invested a meagre of 1.3% toward strengthening the health infrastructure. Under the Modi government, it has plummeted further to only 1.2% of India’s GDP! 

The report published by the CAG bares the discrepancies in India’s healthcare scenario by illustrating the brutal gap between the development on paper versus the ground reality.