The healthcare cover plan of Rs 5 lakh to 10 crore poor families, known as Ayushman Bharat aka Modicare, is not immune from frauds, NITI Aayog member V K Paul hinted, stating: There is a possibility of fraud happening at almost every level and every point of transaction. Speaking with the Financial Express, V K Paul said that it will depend on “the groups of people working on it, and the composite report that has been created, which lists all the points where fraud can happen and how best we can address it”.
V K Paul was responding to a question about a similar healthcare scheme in Rajasthan ‘Bhamashah’ in which the premium increased from Rs 300 to Rs 1,300 in just over two years. “No matter what precautions you take, there will be an issue of insurance companies trying to make money. In some cases, not specific to the Rajasthan scheme, there was cartelisation by companies.
They probably made losses after the first year because the premium was too low. So the next year they raised it all together. Now, these are bad practices and have to be tackled. That is where the system would come in,” V K Paul said.
The NITI Aayog member said that globally, 8-9 per cent of expense in these schemes is lost to fraud. “Information technology will be an interesting way to tackle frauds. The paperless audit system will also help in fraud mitigation and prevention,” he added.
Giving the example of Rashtriya Swasthya Bima Yojana, V K Paul said, the government rationalised the role of the insurance companies, as the accountability to deliver lied with the State. “Accountability to take care of frauds is with the State,” he said.
In the Budget 2018, Finance Minister Arun Jaitley proposed to provide Rs 5 lakh healthcare cover to 10 crore poor families and the provisional budget set was Rs 2,000 crore. The healthcare plan is yet to be implemented. The government is hoping to have the final blueprint of the plan by August 15, which will mark India’s 72nd Independence Day anniversary.
Although beneficiaries have been identified and the IT infrastructure has been put in place, the involvement of hospitals — public and private — and insurance companies was still to be finalised, Bloomberg reported quoting Indu Bhushan, chief executive officer of the project.