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Private hospitals siphon off hundreds of crores in AP, T
Despite Officials Uncovering Scam Last November, The Two Govts Are Yet To Act
Private hospitals in Telangana and Andhra Pradesh siphoned off hundreds of crores of public money between 2007 and 2014, but the two state governments do not want to act on it.It was the vigilance and enforcement department of united AP that took the lid off the scam in November 2013.
Their report, submitted to the higher authorities, exposed how private referral hospitals cheated the state on two counts. First, they did not comply with the rule of providing free treatment to 5% Below Poverty Line (BPL) patients and second, they resorted to excess billing of government employees and later sought reimbursements.
The first category of fraud was detected by the vigilance officials after they randomly inspected 69 out of 827 private referral hospitals in 21 districts and found that all 69 were guilty of non-compliance of the Memorandum of Understanding (MoU) they entered into with the state that gave them recognition as referral hospitals for government employees, retired pensioners, MLAs, ex-MLAs and their dependents.
The report, signed by the then director general R.P Thakur, says that three hospitals inspected out of 198 private referral hospitals in Hyderabad claimed they had provided free medical treat ment to BPL in-patients and outpatients, but also claimed those bills under the Aarogyasri scheme.
“Hardly any of the 827 private referral hospitals followed the free treatment rule, as per the conditions laid down in the MoU signed with the state in 2005. If one were to calculate the loss, it would run into hundreds of crores,“ said Shankar Rajasekharan, trustee of NGO Right to Health (RTH), which analysed the vigilance report in possession with TOI.
After Hyderabad, the maximum number of guilty hospitals was found in East Godavari (65), Kurnool (63), Krishna (61), Visakhapatnam (44), Warangal (41), Karim nagar (41) and Chittoor (41).
However, the second part of the fraud is more extensive.On page 18, the vigilance report notes that the private hospitals collected excessive charges from government servants against the prevailing central government health scheme (CGHS) rates.This fraud was detected when vigilance officials randomly investigated 39 patients treated by Hyderabad-based referral hospitals. They concluded that they caused a loss of Rs 81 lakh to the state by collecting this amount in excess of the actual cost of treatment, which stood at Rs 32 lakh, a percentage rise of 253% against what is permissible! What's shocking is that the exact magnitude of the overbilling fraud by private referral hospitals in the two states was officially pegged at Rs 524.95 crore from 2007 to 2014 in a reply under the Right to Information (RTI) query put up by the NGO.
The year-wise break-up of excess bills collected for treating government employees stands at Rs 13.05 crore (2007), Rs 45.90 crore (2008), Rs 49.11 crore (2009), Rs 72.88 crore (2010), Rs 93.82 crore (2011), Rs 89.74 crore (2012), Rs 105.57 crore (2013) and Rs 54.84 crore (2014 upto May).
Meanwhile, both the Directors of Medical Education (DMEs) of Telangana and Andhra Pradesh, who are the supervising authority to check such medical frauds, washed their hands off the matter. “During my tenure as the DME of integrated AP when the vigilance report came in, I issued necessary instructions to prevent referral hospitals from overbilling. However, recovery of the excess amount is not in my hands and I can do so only if the state instructs me,“ said Dr G Shanta Rao, DME, AP .On his part, Dr Putta Srinivas, DME of Telangana, took a defensive line, saying he will comment on the issue only after examining the file.