Even the dead can be treated! CAG report says Rs 7 cr spent on 'dead' patients under PMJAY

NT Correspondent

New Delhi: The Comptroller and Auditor General (CAG) of India has highlighted that a sum of Rs 6.97 crore was disbursed under the Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana to cover the medical expenses of 3,446 individuals who were previously recorded as deceased, as reported by a media house.

Launched in 2018, the Pradhan Mantri Jan Arogya Yojana (PMJAY) is the flagship health insurance initiative of the Central government aimed at providing coverage to economically disadvantaged citizens.

This program offers health insurance benefits of up to Rs 5 lakh per family. During a performance audit, the CAG discovered that patients previously listed as "deceased" in the Transaction Management System of the scheme continued to receive medical treatment within the program.

The auditor revealed that there were 3,903 such claims, relating to 3,446 patients. The audit disclosed that the highest number of these "deceased" patients, amounting to 966, were identified in Kerala, where their treatment incurred a cost of Rs 2.60 crore.

Following Kerala were Madhya Pradesh with 403 patients (resulting in Rs 1.12 cr in expenses), and Chhattisgarh with 365 patients (resulting in Rs 33.70 lakh in expenses).

As per the regulations, if a patient passes away after being admitted to a hospital but before discharge, the payment to the hospital is made after undergoing an audit.

The CAG's report noted that it had initially raised concerns regarding the registration of deceased patients with the National Health Authority in 2020.

"Despite the audit observation, NHA acknowledged the concern and intimated in July 2020 that a control mechanism had been introduced on April 22, 2020, to deactivate the PMJAY ID of any patient marked as deceased in the TMS [Transaction Management System], preventing them from further availing benefits under the scheme," the report stated.