Hospitals sending forged bills for claims to SHA
Wednesday, 02 March 2022 | PNS | Dehradun
The State Health Agency (SHA) has found that Sitarganj and Jaspur based branches of Ayushman Speciality Hospital Kashipur have submitted bogus pathology bills to defraud it. An investigation by the agency overseeing the functioning of flagship Atal Ayushman Uttarakhand Yojana (AAUY) in the state reveals that these two branches of Ayushman Speciality hospital had submitted bogus bills worth Rs 10.39 lakh to the SHA as claims for treating the patients. Recently a case was registered against the Ayushman Speciality hospital, Kashipur and its empanelment was cancelled by SHA after an investigation revealed that it has submitted fictitious pathology bills in 1,324 cases and produced a claim of Rs 3.42 crore.
In the latest case this hospital’s branches located at Sitarganj and Jaspur were also found involved in a similar fraud. As was the case in the Kashipur’s hospitals, these two branches also used forged signatures and seals of Dr Yogesh Swami in its pathology reports. In the investigation the bills have been found bogus and Dr Swami also has submitted that he has no relationship with the hospital in any capacity. The Sitarganj branch has submitted claims worth Rs 7.82 lakh in 27 cases while the Jaspur branch has submitted claims of Rs 2.57 lakh in 22 cases.
Interestingly, the bills submitted by Kashipur hospital and its branches of Jaspur and Sitarganj have used the seal and signature of pathologist Dr Yohesh Swami. The investigation of SHA conclusively found that Dr Swami is not at all associated with the hospital.
Launched in December 25, 2018, the AAUY provides a cover of Rs five lakh per annum to all 23 lakh families of Uttarakhand in the panelled hospitals under the scheme. Patients can avail benefit of the scheme for 1,350 types of diseases in these hospitals. For treatment in the private empanelled hospitals, the patients are needed to be referred from the government hospitals. However in the case of emergency the patients can directly get admitted in the panelled hospitals. The hospitals in the panel of the scheme produce claims of the treatment done by them and the SHA settles these claims. In many cases the agency has found that the hospitals either produce false claims or overcharge it.
