Union Health Ministry Refutes Reports of Deceased Individuals Receiving PM-JAY Treatment

The controversy arose from media reports indicating that the CAG expressed concerns on treatments being scheduled for deceased AB PM-JAY beneficiaries. There were also allegations of beneficiaries receiving care at two hospitals simultaneously.

Refuting recent media reports, the Union Health Ministry has categorically denied allegations that said deceased beneficiaries of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) are still receiving medical treatment through the system. The ministry clarified these reports as misleading and emphasised that mobile numbers do not determine beneficiary eligibility.

The controversy stemmed from recent media reports that claimed that the Comptroller and Auditor General of India (CAG) had raised concerns about treatments being booked for AB PM-JAY beneficiaries who were marked deceased in the system. Additionally, it was alleged that some beneficiaries were simultaneously receiving treatment at two different hospitals.

The Health Ministry strongly rejected these claims, asserting that the media reports were "completely misleading and ill-informed." The ministry revealed that the CAG's Performance Audit report on AB PM-JAY, which covered September 2018 to March 2021, was presented in the Monsoon Session 2023.

Addressing the alleged instances of beneficiaries receiving treatment after their demise, the ministry explained that hospitals are allowed to initiate pre-authorisation requests up to three days after the admission date.

This provision prevents treatment denials due to limited connectivity or emergencies. In some cases, patients were admitted and unfortunately passed away before their pre-authorisation requests could be raised. The ministry stressed that hospitals themselves reported these deaths, negating the possibility of any fraudulent intent.

Moreover, the ministry pointed out that over 50% of the cases highlighted in the report were attributed to public hospitals, which have no incentive to engage in fraudulent activities, as reimbursements are made directly to their accounts.

Regarding the issue of patients receiving treatment in two hospitals simultaneously, the ministry clarified that children up to the age of five can avail treatment using their parents' Ayushman Cards. This provision allows two different hospitals to simultaneously provide treatment to the child and one of the parents.

The Health Ministry also highlighted that beneficiary identification under AB PM-JAY relies on Aadhaar identification, with mobile numbers playing a minimal role. The mobile number is collected solely for communication and feedback purposes and is not linked to beneficiary verification.

The ministry acknowledged that many beneficiaries in the target group might not possess or frequently change their mobile numbers. Alternative verification methods such as fingerprints, iris scans, and face authorisation have been introduced to accommodate this.

The ministry refuted the notion that treatment could be withheld without a valid mobile number. PM-JAY is an entitlement-based scheme, not an enrolment-based one, meaning the beneficiary database is fixed and cannot be modified to include new beneficiaries.

The ministry acknowledged that during the initial stages of the scheme, some random ten-digit mobile numbers might have been entered by field-level workers since OTP-based validation was not initially in place. This was due to beneficiaries either not having their mobile phones with them or providing the number of a relative or neighbour.

Further, in response to the CAG's audit recommendations, the National Health Authority and the Ministry of Health and Family Welfare are actively examining ways to enhance the system's robustness, efficiency, and prudence.