25 Pune district hospitals under scanner for violating Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

These hospitals were found to exploit patients by demanding money for the cashless treatment scheme, said officials

Twenty-five hospitals in the Pune district have been served with a show cause notice for violating the terms of the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), the state’s cashless insurance scheme. 

According to officials, All these hospitals are frequent violators, which were found to exploit patients by demanding money for the cashless treatment scheme.

The MPJAY is a flagship cashless health insurance scheme launched by the Maharashtra government in 2012. It is currently offered in 966 hospitals (both government and private) throughout the state, as well as 66 hospitals (53 private and 13 government) in the Pune district.

This scheme guarantees an amount of ₹1.5 lakh per year per household, and ₹2.5 lakh for renal transplants.

According to Dr Vaibhav Gaikwad, district coordinator of MPJAY, all 25 facilities slapped with the notice are private hospitals that have been proven to consistently violate the regulations.

“Even though the scheme is cashless, the majority of the cases involve hospitals demanding money from the patients. The empanelled hospitals are not allowed to charge patients anything. In some circumstances, patients were told to go out and buy drugs, injections, implants, or stents for cardiac problems, which is also against the scheme,” he explained.

This scheme covers a total of 996 diseases divided into 30 separate categories. People with yellow, Antyodaya or Annapurna ration cards for people living below the poverty line (BPL) are eligible.

According to officials, those with an annual income of up to ₹1 lakh (orange ration card) are also eligible, as are farmers’ families from suicide-prone areas, even if they have a white ration card (annual income of more than ₹1 lakh).

Dr Gaikwad went on to say, “All complaints are valid and supported by documentation. As a result, we have put the payment to these institutions for the treatment of those patients who have filed the complaint on hold. The payment won’t be cleared unless the complaint is solved. The show cause notices have been issued and further action will be taken based on the explanation,” he explained.

Under the MPJAY scheme in the year April 2022 to March 2023, as many as 66,815 patients have availed healthcare treatment worth ₹172 crores. It was discovered that, despite government restrictions, most hospitals continued to exploit patients, and the administration received 252 complaints against medical facilities in the state this year. 147 of them have been resolved, while the remaining 105 are still pending.

Another senior officer, who requested anonymity, stated that the majority of the accusations involve large private hospitals and private medical institutes. “The majority of these hospitals have multiple complaints.” There are multiple complaints about most of these hospitals. Out of these 252 complaints, almost 75 per cent of the complaints received are regarding illegal demand for money and 25 per cent about denial of treatment. But whenever the payment is put on hold the hospitals try to resolve the complaint. As the money taken from the patients is less in comparison to the payment amount kept on hold. Mostly the hospitals refund the money to the patients and close the complaint,” the official explained.