Probe Finds 49% of Audited Cardiac Cases Lacked Medical Justification; Doctor Accused of False Claims, Forcing Beneficiaries to Pay Despite Cashless Scheme
Experts have found that 27 (49%) out of 55 patients at Department of Cardiology at GMC Anantnag who underwent the highly specialized LBBAP procedure reportedly had normal heart function and did not require it.
Srinagar 18 June: The Jammu and Kashmir Government has initiated major disciplinary proceedings against a cardiologist posted at Government Medical College (GMC) Anantnag after an anti-fraud investigation allegedly uncovered large-scale irregularities in advanced cardiac procedures carried out under the Ayushman Bharat PM-JAY/SEHAT scheme.
Official documents reveal that the Health and Medical Education (H&ME) Department has proposed action under the Jammu and Kashmir Civil Services (Classification, Control and Appeal) Rules, 1956, following findings of alleged medical fraud, data manipulation and financial irregularities linked to cardiac procedures performed at the institution.
According to the charges framed by the department, the doctor allegedly booked and claimed 103 cases under the “Dual Chamber Pacemaker Implantation” package on the Transaction Management System (TMS), while physical records reportedly indicated that a different cardiac procedure—Left Bundle Branch Area Pacing (LBBAP)—had actually been performed.
The matter came under scrutiny after the State Anti-Fraud Unit (SAFU) received complaints regarding suspected out-of-pocket expenditures by beneficiaries enrolled under the PM-JAY/SEHAT scheme. Subsequent audits of the online claims system reportedly revealed unusual patterns in the cardiology department.
A detailed review was later referred to independent experts from SKIMS Soura, who examined a sample of 55 LBBAP cases. According to the audit findings cited in the official record, 27 patients, constituting nearly 49 percent of the evaluated cases, were found to have normal left ventricular function and conditions that allegedly did not justify the specialised procedure.
The expert panel reportedly concluded that these cases lacked the necessary clinical indications for LBBAP, leading the State Health Agency (SHA) to reject several claims on grounds of suspected medical fraud.
The investigation has also raised concerns regarding alleged violations of the PM-JAY/SEHAT scheme’s cashless treatment mandate. Officials claim that some beneficiaries were made to incur out-of-pocket expenses despite the scheme providing free treatment in government hospitals.
One such case cited in the investigation involves a patient who allegedly paid ₹70,000 to a private firm for a cardiac procedure. According to investigators, beneficiary verification and home visits confirmed the payment, which was reportedly made outside the authorised hospital system.
The probe further alleges that established procurement and accountability procedures were bypassed during the acquisition of medical hardware used in certain procedures. Investigators claim that some implants and equipment could not be traced to authorised hospital inventories and that mandatory approvals from designated authorities were absent from records examined during the inquiry.
The department has also alleged obstruction during the investigation, claiming that procurement-related information sought from certain quarters was not made available despite repeated requests.
The evidence compiled by the government reportedly includes digital claim records, operation theatre documents, cath lab registers, procurement records, invoices and statements from patients and medical officials.
The Health and Medical Education Department has issued a formal charge notice to the doctor and granted seven days to submit a written defence. Officials said that if no response is received within the stipulated period, further proceedings may be conducted ex-parte.
The government has described the alleged acts as serious misconduct, abuse of official position and violation of professional responsibilities. Further action, including disciplinary proceedings, will be decided after examination of the doctor’s response and completion of the inquiry process.