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In a startling disclosure, the Comptroller and Auditor General of India (CAG) has revealed significant discrepancies in the registration and validation of beneficiaries under the Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (PMJAY). This central government health initiative offers free and cashless medical treatments to qualified beneficiaries. Spanning from September 2018 to March 2021, the CAG report has highlighted issues including beneficiary validation errors, shortcomings in claim handling, lapses by state health authorities , and more. The scheme operates under the auspices of the National Health Authority, affiliated with the union health ministry.
Mint delves deeper into the report’s findings.
What is the PMJAY scheme?
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana was launched on 23 September 2018. The scheme aims to provide a health cover of ₹ 5 lakh per family per year to over 10.741 crore families from the poor and vulnerable section of the population. PMJAY is an entitlement-based scheme which aims to improve affordability, accessibility, and quality of care for the poor and vulnerable section of the population.
So far, 5,47,68,027 hospital admissions have been authorized and 24,42,78,276 Ayushman cards have been created under the scheme.
What did the CAG audit of the scheme uncover?
The CAG report said that in the absence of adequate validation controls, errors were noticed in beneficiary database i.e., invalid names, unrealistic date of birth, duplicate PMJAY IDs, unrealistic size of family members in a household, among others.
For instance, multiple PMJAY beneficiaries were found to be linked with the same mobile number. These are invalid mobile numbers like 9999888877, 8888443322 etc. This suggests that a large number of beneficiaries would have become eligible under the scheme fraudulently and would have availed treatment causing loss to exchequer.
What does the government have to say on the findings of the report?
Ayushman Bharat PMJAY identifies beneficiaries through Aadhaar identification wherein the beneficiary undergoes the process of mandatory Aadhaar based e-KYC. The details fetched from the Aadhar database are matched with the source database and accordingly, the request for Ayushman card is approved or rejected based on the beneficiary details. However, there is no role of mobile numbers in the verification process. The mobile number is captured only for the sake of reaching out to the beneficiaries in case of any need and for collecting feedback regarding the treatment provided.
Is it true that the same random ten-digit mobile numbers were entered for beneficiary registration & verification?
With regard to the use of the same mobile number by multiple beneficiaries, the government has said that the performance audit has been done during initial and incipient stages of the scheme. The deployed Pradhan Mantri Ayushman Mitra during the initial stages would enter random numbers as provided against beneficiary population to save on time and address large queues in the hospitals. Also, initially the mobile number was not a mandatory field during beneficiary verification. And therefore, mobile numbers were not validated in the process. Meanwhile, necessary changes have been made in the current portal used by NHA for capturing valid mobile numbers, the same possessed by the beneficiary.
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