Mumbai, August 6: The Maharashtra government has established a Special Investigation Team (SIT) to conduct a thorough investigation into 15,407 suspicious medical treatment claims recorded between 2024 and 2026 under the Ayushman Bharat-PM Jan Arogya Yojana (AB-PMJAY) and the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY).
This decision was announced on Wednesday through a government resolution (GR) following directives from Chief Minister Devendra Fadnavis during a meeting held on July 10.
The SIT will be led by Nashik Division Commissioner Praveen Gedam and will include senior officials from the Public Health Department, Information Technology Department, Cyber Police, Economic Offenses Wing, and the Health Department.
If necessary, expert doctors from the Medical Education Department will also assist the SIT.
Previously, civil surgeons and district health officials were instructed to verify suspicious claims by visiting the beneficiaries’ homes. However, preliminary investigations revealed that alleged irregularities were widespread across several districts. Consequently, the state government decided to conduct a comprehensive investigation through an independent SIT.
The SIT will examine various aspects, including fraudulent or medically unnecessary treatment claims at hospitals, improper upcoding of treatment categories, irregularities in the inclusion and renewal processes of hospitals on the panel, suspicious patient registrations, multiple claims under a single mobile number or identification document, and the potential roles of third-party administrators, district coordinators, and other related parties.
Additionally, the SIT is tasked with studying flaws in the claim approval process, monitoring systems, and the hospital panel selection system. They will also provide recommendations to prevent such discrepancies in the future.
According to the government order, the SIT must complete its investigation and submit a report to the state government within 30 days. Based on the investigation report, further legal and administrative actions against the guilty parties will be determined.
During the monsoon session, State Public Health Minister Prakash Abitkar stated in the assembly that treatment up to ₹5 lakh under the Mahatma Phule Jan Arogya Yojana and Ayushman Bharat scheme is entirely free and cashless.
He emphasized that no patient should be charged ‘even a single rupee extra.’ Abitkar warned that any hospital found charging beneficiaries additional fees would be immediately removed from the scheme and face criminal action, including FIRs.
The minister also noted that some private hospitals have been making excuses about bed availability for scheme beneficiaries. To address this, the health department announced the launch of a real-time bed tracking dashboard.
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