The deaths of two beneficiaries under the Pradhan Mantri Jan Arogya Yojana-Mukhyamantri Amrutam (PMJAY-MA) scheme at a private hospital in Ahmedabad earlier this month have brought attention to the misuse of the Central government healthcare programme in Gujarat. Over the past year, at least seven hospitals and clinics have faced suspension or de-empanelment from the scheme due to allegations of fraud and malpractice.
An FIR filed against the owners of Khyati Hospital in Ahmedabad accuses them of performing unnecessary angioplasties for financial gain through claims under the PMJAY-MA scheme. These alleged procedures led to the deaths of two patients. The hospital was de-empanelled and blacklisted on November 13.
The hospital reportedly recruited patients from a medical camp in Mehsana, conducting angioplasties on seven individuals without proper consent. Among them, 77-year-old Bachhu Govaji Barot described the ordeal as traumatic, demanding justice and compensation. Six individuals, including the visiting cardiologist, Dr Prashant Vazirani, have been arrested. Dr Vazirani, accused of performing unnecessary surgeries for illicit gains, has been suspended from the scheme.
According to Dhananjay Dwivedi, Gujarat’s Principal Secretary of Health, inspections by the State Anti-Fraud Unit (SAFU) in 95 hospitals over the past year uncovered significant irregularities. These investigations led to penalties amounting to Rs 20 crore and the return of Rs 44 lakh to 1,024 beneficiaries. Seven hospitals and four doctors were suspended for severe violations, with fines totalling Rs 8.94 crore.
Other Cases
- Naritva Women’s Medical Studio, Ahmedabad
Suspended on October 25 and fined Rs 1.22 crore for “upcoding” claims, the facility was found to have inflated procedures, such as those related to childbirth. Owned by Turning Point Health Care Pvt Ltd, the facility has three premises – in Bapunagar, New Naroda and Gota – in Ahmedabad. It is spearheaded by Group CEO Dr Vijay Pandya. - Nihit Babycare Children Hospital, Rajkot
Found guilty of manipulating medical records for financial gain, the hospital was fined Rs 6.54 crore and suspended on June 27. Its owner, Dr Hiren Mashru, allegedly forged pathological and X-ray reports over 10 months. - Sunshine Global Hospital, Vadodara and Surat
The Vadodara facility was suspended for deficiencies in its oncology department and fined Rs 10.84 lakh. Further, during an inspection, Surgical Oncologist Dr Mihir Shah was found to be engaged in alleged “upcoding” of surgical packages. He was also suspended from the scheme. The Surat branch was fined Rs 1.06 crore after inspectors found fraudulent signatures on Tumour Board Certificates. - Everest Hospital, Una
Suspended due to the absence of a Building Use permission from the local civic body, though no medical or financial irregularities were reported. This hospital was suspended from all specialities on June 27. No fine was imposed. - Shiv Hospital, Ahmedabad
Penalised Rs 5,600 for overcharging patients, the hospital was suspended in June. - Samanvay Hospitals, Junagadh
Radiation Oncologist Dr Ketan Kalariya was suspended for “upcoding” radiation package claims on the PMJAY site. He was suspended from the scheme on October 25.
From August 2023 to February 2024, tensions arose between private hospitals and the Gujarat government over unpaid dues amounting to Rs 650 crore. Following negotiations involving state and Union Health Ministers, the issue was largely resolved earlier this year, with payment procedures amended to address hospital concerns.
Dr Bharat Gadhvi, Convener of the Gujarat Association of Hospitals and Nursing Homes, stated, “While there were payment issues, they have largely been resolved with the intervention of ministers Mansukh Mandaviya and Rushikesh Patel. Hospitals are now better aligned with the scheme’s procedures.”
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