Worli Police Register FIR In ₹1.79 Crore Health Scheme Fraud; Three Nashik Hospitals Accused Of 361 Fake Insurance Claims

Mumbai: The Worli Police have registered an FIR in connection with an alleged fraud involving ₹1.79 crore siphoned off from the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) by submitting fake insurance claims in the names of patients who allegedly never received treatment.

The complaint was lodged by Chandrakant Vibhute, Chief Executive Officer of the State Health Assurance Society, against the managements of three private hospitals in Nashik. The accused have been booked for allegedly cheating the government and misappropriating public funds by using forged medical records and fraudulent insurance claims. Police have initiated an investigation into the case.

According to the complaint, a verification of insurance claims by the State Health Assurance Society revealed that records of treatment provided to 361 patients were fabricated. The accused allegedly misused beneficiaries' documents, created forged medical records, uploaded the false information on the Jeevandayee portal, and obtained approval for online insurance claims, resulting in the fraudulent withdrawal of government funds.

The investigation found that Shiv Multispeciality and Critical Care Hospital, Satpur, allegedly received ₹71.83 lakh through 163 fake claims. Nashik Grace Hospital, CIDCO, allegedly obtained ₹62.13 lakh through 126 fraudulent claims, while Rishikesh Hospital, Gangapur Road, allegedly received ₹45.45 lakh through 72 fake claims.

An FIR has been registered against the founders, authorised signatories, and the concerned account holders of the three hospitals. The Worli Police are also investigating whether a larger racket or other individuals were involved in the fraud. The alleged scam has raised serious concerns over the misuse of government-funded healthcare schemes and has sent shockwaves through the health department.

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