27 hospitals were removed from the network of empanelled institutions under the scheme, confirmed Dr Sudhakar Shinde
In a major crackdown on alleged malpractices in one of the state's largest welfare schemes, 27 hospitals have been de-empanelled from the Mahatma Jyotiba Phule Jan Arogya Yojana (MPJAY) for reasons ranging from manipulation in medical records, complaints about the collection of money and poor performance.
Officials said this was the highest number of hospitals which were de-empanelled at one go from the MPJAY, which is the state government's cashless medical insurance scheme. It covers beneficiaries from around 2.25 crore BPL and APL ration card holding families for hospitalisation coverage up to Rs 1.50 lakh on floater basis in empanelled hospitals.
"27 hospitals were removed from the network of empanelled institutions under the scheme," confirmed Dr Sudhakar Shinde, CEO of MPJAY.
These hospitals include those in Mumbai (one), Nagpur and Nashik (three each), and Pune and Thane (two each). Reasons include complaints about collection of money from beneficiaries (despite this being a cashless scheme), not replying to show-cause notices, manipulation of medical records, inactivity, poor performance and low bed strength. Two hospitals, one each in Mumbai and Pune, have been removed at their own request.
Shinde added that they had empanelled 32 hospitals including those at the taluka level to take MPJAY to the grassroots.
When contacted, Dr Shweta Singh, COO, Vijay Vallabh Hospital at Virar, which has been de-empanelled for "money collection grievances and manipulation of medical records (X-ray)," she said they had voluntarily surrendered their empanellment. "There is a lot of nuisance by (MPJAY) field officers," said Singh, adding it was a "money making business for these officers."
Officials said though 211 hospitals had been de-empanelled since the scheme's inception in 2012, this was the highest number of actions taken at one go. A total of 492 hospitals across Maharashtra are empanelled to conduct 974 therapies and surgeries with 121 follow-up packages in 30 identified specialities like general surgery, pediatric surgery and radiation oncology. This largely covers secondary and tertiary treatment.
"We placed 21 hospitals under suspension, of which seven were finally de-empanelled, six continue to be suspended and action against eight has been revoked," an official revealed.
Around 1,000 patients are enrolled daily under the MPJAY for treatment and about 3.5 lakh procedures are conducted annually. So far, 19 lakh procedures have been completed. The state pays an annual premium of Rs 1,600 crore to the insurer.
Shinde said they were focussing on awareness for patients through measures like calls on patients numbers for feedback and were looking at "weeding out low-performers."
He added that tighter monitoring ensured an around 5-7 per cent drop in claims filed by hospitals in around a month, resulting in savings of around Rs 100 crore. Claims worth around Rs 1,500 crore are paid annually.
Launched as the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY), the scheme was re-christened as MPJAY in 2017.
In 2016, the state legislature's estimates committee had red-flagged lacunae in the scheme including the use of cheap quality critical equipment like pacemakers, valves, and stents, which adversely affect the health of patients and reuse of consumables.
GRIEVANCES
- Deshpande Hospital, Ahmednagar: Money collection grievances, inactive specialities, no reply to nine show cause notices sent by TPA
- Shat-Ayu hospital, Nagpur: Money collection grievances, manipulation of medical records (X-ray)
- Dr R.N Patil’s Suraj Hospital, Thane: Low-performance
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