3 weeks ago
Patients Treated for One Ailment, Hospitals Bill Another in Bhopal
The government of India runs a special health program called Ayushman Bharat that pays hospitals to treat sick people who cannot afford it.
But some private hospitals in the state of Madhya Pradesh are accused of cheating this program.
They are accused of treating a patient for one illness but writing on the paperwork that they treated a different, more expensive illness, so they could get more money.
Some hospitals are also accused of collecting people's fingerprints and ID numbers without explaining why, and then using that information to file claims.
A man named Shyam went to a hospital in Bhopal for treatment of piles, but his papers said he had surgery for kidney stones, and money was taken from his insurance account.
A woman named Rekha went to a hospital in Narmadapuram for a fracture, but was reportedly billed for two surgeries that were not connected to her condition.
A government doctor in Narmadapuram said an inquiry found the hospital guilty of fraud and recommended stopping it from taking part in the program.
Another patient in Jabalpur said his insurance account still showed he was in hospital even after he went home, and big claims were raised without his knowledge.
When asked, one hospital denied any wrongdoing, while another did not answer.
Cheating a health program is not fair because it takes money away from helping people who really need medical care.
Private hospitals in Madhya Pradesh are accused of claiming higher Ayushman Bharat reimbursements by billing for diseases different from those actually treated.
In Bhopal, patient Shyam Kumar's records showed kidney stone surgery though he was treated for piles, and ₹84,260 was deducted from his Ayushman account.
An official inquiry found Meena Fracture Hospital in Narmadapuram guilty of negligence, financial irregularities and fraud, recommending cancellation of its empanelment.
A patient at Swastik Multispeciality Hospital in Jabalpur alleged his Ayushman account stayed active after discharge, with claims worth several lakh rupees raised without his knowledge.
Hospitals allegedly collected patients' Aadhaar details and biometrics without explaining the purpose and raised claims under the scheme without their consent.
- Who
- Patients such as Shyam Kumar, Rekha Ahirwar and a Jabalpur man, and accused private hospitals: RA Stone and Surgical Care, Meena Fracture Hospital and Swastik Multispeciality Hospital.
- What
- Allegations of large-scale fraud under the Ayushman Bharat scheme, with hospitals claiming higher reimbursements by recording treatment for different diseases and raising claims without patients' knowledge.
- Where
- Bhopal, Narmadapuram and Jabalpur in Madhya Pradesh, India.
- When
- No specific dates are stated in the article; complaints were filed and inquiries were conducted recently.
- Why
- To obtain higher payouts under the government-funded Ayushman Bharat health insurance scheme.
Patients and Officials
Accused Hospitals
Billing and treatment records
Patients and Officials
Hospitals billed for different diseases than those actually treated (e.g., kidney stone surgery instead of piles) to claim higher payouts, and raised claims without patients' knowledge.
Accused Hospitals
RA Stone and Surgical Care denied any wrongdoing and said patients with grievances should approach the hospital administration directly.
Account claims
Patients and Officials
A Jabalpur patient alleged his Ayushman account stayed active after discharge and claims worth several lakh rupees were raised against it without his knowledge.
Accused Hospitals
Swastik Multispeciality Hospital did not respond to Free Press despite repeated attempts.
Key facts
- Scheme
- Ayushman Bharat (government-funded health insurance)
- State
- Madhya Pradesh, India
- Accused hospitals
- RA Stone and Surgical Care (Bhopal), Meena Fracture Hospital (Narmadapuram), Swastik Multispeciality Hospital (Jabalpur)
- Amount deducted in Bhopal case
- ₹84,260 from Shyam Kumar's Ayushman account
- Inquiry finding (Narmadapuram)
- Meena Fracture Hospital guilty of negligence, financial irregularities and fraud
- Recommended action
- Immediate cancellation of Meena Fracture Hospital's empanelment under Ayushman Bharat
- Complaints filed
- CM Helpline, Jansunwai, and the chief medical and health officer (CMHO)









