India’s Public Health Scheme Reveals Discrepancies Leading to Ineligible Beneficiaries and Wasted Expenditure
India’s public health assurance scheme, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), has been found to have significant discrepancies in its beneficiary database, resulting in crores of rupees in expenditure on ineligible beneficiaries. A performance audit conducted by the Comptroller and Auditor General highlighted inadequate validation controls as the main cause of these errors. The government’s auditor noted issues such as invalid names, unrealistic dates of birth, duplicate health IDs, and unrealistic family sizes within the database.
The report revealed numerous instances of multiple registrations against the same Aadhaar numbers, with 36 cases involving two registrations against 18 Aadhaar numbers and 4,761 registrations against seven Aadhaar numbers in Tamil Nadu alone. The Beneficiary Identification System (BIS) also identified thousands of beneficiaries registered against invalid or duplicate mobile numbers. Such discrepancies have led to wasted expenditure and benefits being availed by ineligible households.
Between 2018 and 2021, health authorities in Jammu & Kashmir and Ladakh identified 16,865 and 335 ineligible beneficiaries, respectively, after cleaning the data of the Socio Economic and Caste Census. It was discovered that ineligible households in six states and Union territories had registered as PMJAY beneficiaries and availed the scheme’s benefits. The expenditure on these ineligible beneficiaries ranged from ₹0.12 lakh in Chandigarh to ₹22.44 crore in Tamil Nadu.
The audit report not only highlighted issues with the beneficiary database but also revealed significant gaps in hospital empanelment and management within the scheme. Several states demonstrated shortages in infrastructure, equipment, doctors, and non-functional equipment. The audit found that some Empanelled Health Care Providers (EHCPs) did not meet the minimum criteria for support system and infrastructure and failed to conform to the prescribed quality standards.
Furthermore, many mandatory compliances criteria for empanelment of hospitals were not fully followed, including infrastructure requirements, fire safety measures, biomedical waste management, pollution control, and hospital registration certificates. Some hospitals had expired fire safety certificates before empanelment. Non-compliance with quality standards and criteria jeopardized the safety and well-being of beneficiaries and were mandatory minimum conditions for empanelment.
In terms of hospital availability, the report highlighted significant disparities among states. Bihar had only 1.8 hospitals per lakh beneficiaries, while Goa had 26.6 hospitals. Other states such as Assam, Dadra Nagar Haveli-Daman Diu, Maharashtra, Rajasthan, and Uttar Pradesh had limited access to hospitals. The report specifically mentioned the lack of three specialities in two private hospitals in Jharkhand and the limited availability of facilities in 13 hospitals in Assam.
In response to the audit findings, junior health minister SP Singh Baghel stated that the Indian government utilizes artificial intelligence and machine learning technologies to detect potential fraud and suspicious transactions under AB-PMJAY. These technologies play a vital role in prevention, detection, and deterrence of healthcare frauds, ensuring appropriate treatment for eligible beneficiaries.
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana, launched in 2018, was designed to achieve universal health coverage for approximately 500 million people from 107.4 million families. However, the audit report revealed significant shortcomings in its implementation. It is expected that addressing the observations and recommendations mentioned in the report will help improve the scheme’s implementation and effectiveness.
