Patients Treated For One Ailment, Hospitals Bill For Another For Higher Payouts Across Bhopal

Bhopal (Madhya Pradesh): A patient walks into a private hospital complaining of one illness but is discharged with records showing treatment for an entirely different disease.

Allegations of large-scale fraud under the Ayushman Bharat Scheme have surfaced across the state, with several private hospitals accused of claiming higher reimbursements by showing treatment for diseases different from those actually suffered by patients.

In many cases, hospitals collected patients' Aadhaar details and biometrics without explaining the purpose and later raised claims under the scheme without their knowledge.

The alleged malpractice is not confined to isolated cases but is being reported from several private hospitals across the state. Case studies from Bhopal, Narmadapuram and Jabalpur reveal how patients seeking treatment for one ailment were allegedly shown as having undergone surgeries for entirely different medical conditions, enabling hospitals to claim higher payments under the government-funded health insurance scheme.

RA Stone and Surgical Care, Bhopal

Shyam Kumar approached the hospital for treatment of piles after doctors assured him that he would recover within two weeks following surgery. Before the procedure, hospital staff conducted several tests and repeatedly collected his biometrics and other personal details.

After returning home, Shyam received a message stating that ?84,260 had been deducted from his Ayushman account. His condition, however, failed to improve and the pain became unbearable.

Seeking a second opinion, he consulted a local doctor, who, after examining the discharge papers, informed him that the hospital records showed he had undergone surgery for kidney stones instead of piles. According to Shyam, the hospital initially denied any malpractice.

Shyam also lodged a complaint on the CM Helpline. He told Free Press that hospital representatives later contacted him and assured him that his condition would improve within three months.

When contacted by Free Press, the hospital management denied any wrongdoing. Hospital authorities said that if a patient had any grievance, they should approach the hospital administration directly.

Meena Fracture Hospital, Narmadapuram

A similar matter surfaced against Meena Fracture Hospital in Narmadapuram. Rekha Ahirwar of Pipariya visited the hospital for fracture treatment but later alleged that the hospital claimed reimbursement for procedures unrelated to her actual condition.

According to the complaint, the hospital billed for two surgeries under the Ayushman scheme, leading to a substantial deduction from her insurance cover. Rekha and her husband subsequently filed complaints before the Jansunwai and the chief medical and health officer (CMHO).

Dr Narsingh Gehlot, CMHO of Narmadapuram, said an official inquiry found the hospital guilty of negligence in treatment as well as financial irregularities and fraud under the Ayushman scheme. Based on the findings, the team sent details of the alleged fraud to the Chief Executive Officer of Ayushman Bharat in Bhopal, recommending that the hospital's empanelment under the scheme be cancelled immediately.

Swastik Multispeciality Hospital, Jabalpur

Another issue has surfaced from Swastik Multispeciality Hospital in Jabalpur. A patient alleged that he was admitted to the hospital after experiencing severe chest pain. Following an ECG and other diagnostic tests, he was admitted for further treatment, during which hospital staff collected his Ayushman details and completed the necessary formalities.

According to the patient, his Ayushman account was activated immediately after admission. However, he claimed that even after he was discharged, the Ayushman portal continued to show his admission as active, resulting in claims worth several lakh rupees being raised against his account without his knowledge.

When contacted by Free Press, the hospital did not respond despite repeated attempts.