Imran Naikoo
Srinagar 17 August(KNB): The Comptroller and Auditor General of India (CAG) has highlighted concerns regarding the effectiveness of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) health insurance initiative in Jammu and Kashmir. The PMJAY scheme, aimed at providing health insurance coverage for economically disadvantaged individuals, has faced issues in the region.
CAG’s audit revealed several irregularities, including instances where funds amounting to Rs 10.96 lakhs were disbursed for the treatment of individuals who were previously recorded as deceased in the scheme’s database. Additionally, 35 ineligible beneficiaries and 459 patients were charged Rs 43.27 lakhs for their treatment, resulting in an increase in out-of-pocket expenses for beneficiaries.
The audit further pointed out that penalties were not imposed on the insurer for non-compliance with key performance indicators specified in contract agreements. This lack of penalties allowed defaulting hospitals to deviate from the established performance indicators.
A total of 16,865 ineligible beneficiaries were identified in Jammu & Kashmir and Ladakh, indicating issues with the accuracy of the database. The audit also highlighted delays in empanelling hospitals, rejection of cases, and issues related to incorrect household IDs.
Furthermore, the audit report revealed that certain State Health Agencies (SHAs) failed to remit earned interest and recoverable premiums, leading to financial discrepancies.
In summary, CAG’s audit revealed irregularities and challenges within the Ayushman Bharat PMJAY scheme in Jammu and Kashmir, raising concerns about its efficiency and the need for improvements in its implementation and oversight.(KNB)