The Maharashtra government has constituted a Special Investigation Team (SIT) to investigate 15,407 suspicious health insurance claims flagged under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) for the period between 2024 and 2026.
Nashik Divisional Commissioner to Head Special Investigation Team
According to a Government Resolution issued by the Public Health Department on August 5, the SIT will be headed by Nashik Divisional Commissioner Dr Pravin Gedam and will include senior officials from the Public Health Department, the Electronics, Information Technology and Artificial Intelligence Department, as well as representatives nominated by the Director General of Police, including officers from the Cyber Police Station and the Economic Offences Wing (EOW), Nashik.
The probe will examine alleged irregularities in the flagged claims, including fraudulent or medically unnecessary treatments, inflated treatment packages, violations in hospital empanelment and renewal procedures, involvement of unauthorised agents or intermediaries during patient registration, and instances where multiple claims were linked to the same mobile number or identity proof. The SIT will also investigate the possible role of district coordinators, third-party agencies and other stakeholders associated with the implementation of the schemes.
Probe to Cover Role of Agents, Coordinators and Other Stakeholders
Besides investigating the suspect claims, the SIT has been tasked with recommending corrective measures to strengthen hospital empanelment, claim approval and monitoring mechanisms under both health insurance schemes to prevent future irregularities.
The government has directed the SIT to submit its report within 30 days of its constitution. Required manpower, technical support and operational expenses for the investigation will be provided by the State Health Assurance Society.
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