PM-JAY fraud in hospitals

The Pradhan Mantri Jan Arogya Yojana, or PM-JAY Yojana, which covers medical expenditures up to five lakhs and authorises hundreds of facilities, including private hospitals, to treat patients with specialised medical services, has significantly improved healthcare in Jammu and Kashmir. Residents of Jammu and Kashmir are all entitled to apply for the programme, acquire an Ayushman Bharat card, and take use of its benefits, in contrast to the rest of India, where it is only open to the poor. With only one stroke, the days of excruciatingly long waits in government hospitals for even routine surgery are long gone.

The website provides information about each assigned hospital, making it straightforward to choose a place to receive medical treatment. The GoI also provides a feedback system, as patients do get calls following hospitalisation and use of the services to confirm the validity and calibre of the services and to ensure no payment is necessary on the patient’s part. The PM-JAY programme has been a blessing in disguise for middle-class and underprivileged families since it relieves them of the tax and financial burden of paying for healthcare. Even at government institutions, nurses ensure that holders of Ayushman Bharat cards receive their free medication supply on time.

The burden on government hospitals has greatly diminished, with the exception of chronic diseases, for which it is always recommended to visit GMC Jammu or another sort of specialised government hospital. All diagnostic treatments, including blood tests, ultrasounds, CT scans, and MRIs, are free for patients who are in the hospital. The PM-JAY programme, however, does not pay for these operations for outpatients. Once all is said and done, the Ayushman Bharat Yojana benefits everyone involved: patients receive adequate care at free cost, private hospitals make money, and government hospitals see a slight drop in patient flow compared to usual. Yet, con artists take part in every government programme, and the PM-JAY programme is no different.

For submitting bogus claims under PM-JAY, many private hospitals in Jammu and Kashmir have repeatedly been fined. It is really concerning that certain white-coated guys are acting in such a way while signing an oath to serve mankind. Thirteen hospitals had already been suspended and fined a total of Rs. 1.77 crore; some of these organisations have broken the law in the past. There seems to be a group of hospitals carrying out these abhorrent acts.

Repeat offenders must face harsher penalties from the LG Administration; a suspension is insufficient retribution for patient exploitation and making fake medical claims.

Such incidents shouldn’t cast a negative light on the administration’s worthwhile initiatives. Also, the Medical Council of India has to unite in opposition to these heinous deeds. Greater vigilance is needed; honest hospitals need to be acknowledged with recommendations on official websites, and defaulting hospitals need to be mentioned so that prospective patients may assess their dependability.

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