Govt. Hospital Accused of Using Fake Patients for Insurance

by Lyju Kuruvilla on  November 15, 2011 at 12:42 PM Health Insurance News
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For the first time in Uttar Pradesh, a government hospital has been accused of using fake entries of patients to claim medical insurance for the poor under Rashtriya Swasthya Bima Yojana (RSBY). The 30-bed Community Health Centre in Mehdawal was found to have admitted 44 patients claiming RSBY insurance in one day. On inquiry, it was found that none of these patients was actually admitted in CHC that day.
 Govt. Hospital Accused of Using Fake Patients for Insurance
Govt. Hospital Accused of Using Fake Patients for Insurance

As per the allegations, the Medical Superintendent of CHC, Dr. M K Chaudhary, claimed an insurance of approximately Rs. 1 lakh against treatment of 44 BPL RSBY cardholders at the centre. The large number of admissions attracted the attention of the insurance company ICICI, which sent its team to verify the authenticity of these admissions. On the complaints of the insurance company, a team of officials from the health directorate was sent to probe the matter.

Sources in the Health Department said the investigating team found that only 14 beds were functional in CHC while 6 children's beds were reserved for patients of Japanese encephalitis. Moreover, all the 44 names were written in the outdoor list, but the documents for indoor admissions did not have updated records for the day.

RSBY rules stipulate that insurance can be claimed only if a patient is admitted in hospital for at least 24 hours. The matter of inquiry in this case is that there were 44 patients admitted when the hospital had only 30 beds.

The preliminary report found the Medical Superintendent prima facie guilty and recommended that a high-level committee be formed to conduct a detailed inquiry. It also recommends suspension of the medical superintendent.

As per the RSBY, the money claimed by the government hospitals to provide health facilities to BPL card holders is deposited in the Rogi Kalyan Samiti account of the hospital. The money is used by the hospital authorities for various purposes such as construction, medicine purchase as well as treatment of patients.

Source: Medindia

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