CAG unveils flaws in PMJAY scheme: From several registrations on same number to claims for treatment of dead

A recent report by the Comptroller and Auditor General (CAG) has shed light on critical faults within the database of the Pradhan Mantri Jan Arogya Yojana (PMJAY). Tabled in the Lok Sabha on Monday, the report said that nearly 7.5 lakh beneficiaries were linked with a single cellphone number — 9999999999 — in the Beneficiary Identification System (BIS) of the scheme.

The BIS is a critical component of PMJAY, designed to prevent duplications and ensure that healthcare benefits reach those who are genuinely eligible. However, the presence of a significant number of beneficiaries linked to a single mobile number has put a spotlight on potential fraudulent activities and the misdirection of resources.

With a single mobile number potentially representing multiple beneficiaries, the scope for misuse and diversion of funds becomes evident. Experts suggest that this flaw could be exploited to siphon off benefits meant for deserving individuals or even lead to inflated claims by unscrupulous entities.

According to the report, errors were also noticed in beneficiary databases such as invalid names, unrealistic date of birth, duplicate PMJDY IDs, and unrealistic size of family in a household, among others. In several states, the CAG found a shortage of infrastructure, equipment, and doctors.

The report also said that some of the empanelled hospitals neither fulfilled the minimum criteria of support system and infrastructure nor conformed to the quality standards prescribed under PMJAY guidelines.

In 36 cases, two registrations were made against 18 Aadhaar numbers and in Tamil Nadu, 4,761 registrations were made against seven Aadhaar numbers. In six states and Union territories, ineligible households were found registered as PMJAY beneficiaries and had availed the benefits of the health scheme, the report revealed.

Between 2017 and 2021, as many as 2,103 beneficiaries of the Centre’s social assistance schemes were given pensions even after they had died, according to The Print.

National Health Authority released excess grants to Andhra Pradesh (Rs 8.37 crore) and Mizoram (Rs 10.86 crore) without considering the previous year's balances and upfront shares. Seven State Health Agencies (SHAs) diverted the grant of Rs 50.61 crore from one head to another head. In 20 SHAs, administrative grants of Rs 98.98 crore, Rs 128.13 crore and Rs 139.67 crore remained unspent at the close of 2018-19, 2019-20 and 2020-21, respectively.

Ten SHAs did not remit the interest of Rs 22.17 crore earned by them on unspent grants to NHA. Rs 458.19 crore was recoverable from the insurance companies in six states and UTs. West Bengal withdrew from PMJAY in January 2019 but did not refund Rs 31.28 crore to NHA, the report said.

These revelations have prompted calls for an urgent review of the Beneficiary Identification System, along with enhanced security measures and improved data validation processes. The PMJAY scheme, which was launched with the noble aim of providing accessible healthcare to millions, must ensure that its foundational database is robust, secure, and accurately reflects the beneficiaries it serves.

Pradhan Mantri Jan Arogya Yojana or PMJAY is a component of Ayushman Bharat. This scheme was launched on September 23, 2018, in Ranchi, Jharkhand by Prime Minister Narendra Modi.

Ayushman Bharat PMJAY is the largest health assurance scheme in the world which aims at providing a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to over 12 crore poor and vulnerable families (approximately 55 crore beneficiaries) that form the bottom 40 percent of the Indian population. The households included are based on the deprivation and occupational criteria of the Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas, respectively, and state governments.