5 Gujarat hospitals de-panelled from PMJAY due to irregularities; 2 doctors also face action

Ahmedabad: The Gujarat health ministry on Monday said it has debarred five private hospitals from providing services under the Pradhan Mantri Jan Arogya Yojana (PMJAY) due to irregularities in the last one week, taking the count of medical facilities de-panelled so far in 2024 to 12.

Two doctors working in these hospitals were also suspended from providing services under PMJAY - a flagship health insurance scheme of the Centre - and one of the de-panelled medical facilities was fined Rs 50 lakh.

The action comes in the backdrop of Ahmedabad-based Khyati Multispecialty Hospital caught performing unnecessary angioplasty procedure on several PMJAY cardholders just to siphon off government money.

The scam, in which the private hospital's management and doctors were involved, came to light after two healthy people died following angioplasty, a procedure used to open blocked coronary arteries in heart patients.

"Five empanelled hospitals -- two in Patan district, one each in Dahod, Ahmedabad and Aravalli districts -- and two doctors under PMJAY were suspended in the last one week for irregularities," a release of the health department said.

Heer Children Hospital, and Niskha Children Hospital and Neonatal Care of Patan district, Sonal Hospital of Dahod, Sentora Hospital of Ahmedabad and Shree Jalaram Hospital of Aravalli district were suspended between December 2 and December 8 after an inspection, it said.

During the inspection at Heer Hospital in Patan, it was revealed authorities had changed 91 lab reports to get benefit under PMJAY. It was also found the hospital had applied for higher package under the insurance scheme when it was not required, said the release.

So, Heer Hospital and a doctor working there, Hiren Patel, were suspended from PMJAY empanelment. Health Spring Pathology Laboratory was also suspended from the scheme. A fine of Rs 50 lakh has been imposed on the hospital, it said.

The inspection at Niskha Children Hospital and Neonatal Care has revealed 60 medical reports were changed to get undue benefits under the central scheme. The hospital and its doctor Divyesh Shah were suspended from PMJAY, according to the release.

A recovery notice of Rs 15 lakh has been issued to the hospital, it said.

Sonal Hospital of Dahod did not have required manpower and infrastructure under the scheme and their work regarding infection control was also not up to the mark. Hence, the medical centre was de-empanelled under PMJAY, the health department said.

Sentora Hospital of Ahmedabad did not have Building Use (BU) permission for its fourth and fifth floors and lacked proper staff as well as a modular operation theatre. Medicines past their expiry dates were also recovered from the hospital premises, said the release.

In case of Shree Jalaram Hospital of Aravalli district, a lack of fire certificate and not having intensive care unit (ICU) as per prescribed norms led to its suspension, according to the department.

The release further said since January 2024 the state health department has suspended 12 hospitals from PMJAY for irregularities.

The health department will not allow irregularities in the scheme meant to give free medical treatment to the poor and people from middle class, it emphasised.

In the Khyati Hospital scam, the Ahmedabad crime branch has so far arrested seven persons, including its CEO and director (marketing), after the death of two PMJAY beneficiaries following botched angioplasty procedures last month.

Police investigations were triggered by complaints from the families of the deceased "patients", who were among seven individuals who underwent angioplasty at the hospital on November 11.

The investigations showed the hospital organised free check-up camps in villages to convince PMJAY cardholders to undergo angioplasty, which is covered under the scheme without any payment by patients, despite no medical necessity for the procedure.

Patients were falsely registered under the "emergency" category to expedite government approval. In return, the hospital claimed payments from the government, police have stated.

On November 12, the city's Vastrapur police registered three FIRs over the death of PMJAY beneficiaries due to botched angioplasty and arrested a cardiologist, Dr Prashant Vazirani. The accused were charged with culpable homicide not amounting to murder, forgery, and criminal conspiracy, among others.

The FIRs accused the Khyati hospital management and doctors of conspiring to obtain financial benefits under PMJAY, a scheme implemented by the Centre in partnership with states and Union Territories.