10 more docs under lens over RGHS case
Jaipur, Feb. 15 -- A day after at least seven doctors were suspended for alleged irregularities under the Rajasthan Government Health Scheme (RGHS), officials said nearly 10 more doctors are under scrutiny and may face action soon.
According to people familiar with the matter, several hospitals and pharmacies allegedly prepared fake bills, and uploaded fake claims on the RGHS portal. Apparently, it started in 2021. Many non-empanelled set ups also colluded with the empanelled ones and obtained payments from the government.
Chief executive officer of the state health assurance agency Harji Lal Atal said the ongoing review is part of a systematic audit process. "We have constituted an AI-based team that is examining every claim under RGHS and auditing hospital records. At least 10 more doctors are currently under our lens in cases pertaining to suspected irregularities. The number may increase if more discrepancies are detected," he said.
According to officials, 64 medical staffers, including 14 doctors, have so far been suspended in connection with the alleged RGHS scam across the state. "The seven doctors suspended on Friday are all from Sikar. An audit of the scheme in the district revealed their involvement in irregularities," Atal said.
Those suspended include associate professors Dr Kamal Kumar Agrawal and Dr Sunil Kumar Dhaka of the Orthopaedics Department, and Dr Mukesh Verma of General Medicine at Government Medical College, Sikar; Dr Rakesh Kumar of CHC Kirwa; and Dr Gajraj Singh, Dr SS Rathore and Dr Sunil Sharma of SK Hospital.
A first information report (FIR) has also been registered against Bharatpur Nursing Home and Bothra Diagnostic and Imaging Centre in Bikaner for allegedly raising false claims under RGHS and receiving payments despite not being empaneled under the scheme.
Atal said the irregularities came to light during a probe conducted by the Quality Control and Performance Audit Cell, which has been auditing the scheme since 2021.
Another official familiar with the investigation said some doctors and hospital staff allegedly lured patients by promising treatment under RGHS but were not directly involved in providing care.
"They obtained beneficiaries' IDs and passwords to generate transaction IDs. Bills were later adjusted on the RGHS portal through other empaneled hospitals and pharmacies to claim payments. Commissions were allegedly paid for this arrangement," the official said.
In several cases, empaneled hospitals were found uploading details of expensive medical tests without medical justification. Investigators said the patients never underwent those tests, yet payments were claimed from the government.
So far, FIRs have been lodged against 19 hospitals, eight of which have been de-empaneled.
Accounts of more than 33 hospitals and 212 pharmacies have been frozen, and penalties totaling Rs.32 crore have been imposed. Officials said over 250 hospitals remain under scrutiny....
To read the full article or to get the complete feed from this publication, please
Contact Us.