Rajasthan cracks down on RGHS fraud; FIRs, suspensions, and new anti-fraud measures launched - World News Network

Jaipur (Rajasthan) [India], August 16 (ANI): On the initiative of Chief Minister Bhajan Lal Sharma and under the guidance of Medical Minister Gajendra Singh Khimsar, strong measures are being taken to ensure the smooth functioning of the Rajasthan Government Health Scheme (RGHS).
According to a release, the state government is taking strict action against irregularities committed by hospitals, pharmacy stores, and personnel under the scheme.
As part of this drive, FIRs have been filed against three pharmacy stores and 1 hospital. Additionally, letters have been sent to take action against 473 personnel from five departments, and disciplinary action has also been recommended against eight allopathic and two ayurvedic doctors. Moreover, 12 employees, including two doctors, have been suspended for various irregularities in the scheme.
Principal Secretary of the Medical and Health Department, Gayatri Rathore, stated that complaints had been received for a long time regarding irregularities at various levels by stakeholders in RGHS. These complaints were thoroughly investigated, and an audit was also conducted by the Finance Department.
Based on audit findings, FIRs have been registered against the operators and others associated with Shivam Drug Store in Churu, Guru Kripa Hospital and New India Medical Store in Sikar, Shop No. 3 of Nagaur Cooperative Marketing Society Limited in Merta, Nagaur.
Harji Lal Atal, CEO of the Rajasthan State Health Assurance Agency, stated that letters have been sent to the Education Department (Primary and Secondary), Medical & Health Department, Home Department, Jaipur Discom, and Ayurved Department for taking action against their 473 employees.
These employees are alleged to have misused Ayurvedic treatments like Panchakarma/Shirodhara unnecessarily and colluded with medical stores to create fake prescriptions.
Furthermore, 12 employees from the Commercial Tax, Education, Ayurved, Water Resources, Medical & Health, and Police Departments have been suspended. These employees were found to have misused the scheme by getting treatment done for tenants under the name of their wives, married daughters, siblings or children’s friends under their own or children’s names. The two Ayurvedic doctors in question were allegedly prescribing medicines without any examination, and eight allopathic doctors were found to be writing unnecessary prescriptions and creating fake ones.
Notably, the operation of the RGHS scheme was recently handed over to the Medical and Health Department, after which Minister Gajendra Singh Khimsar had instructed for strict action against hospitals, pharmacy stores, and other stakeholders involved in irregularities and fraud. He emphasised the need for transparency, financial strength, and institutional restructuring in the scheme’s operation. He also directed for technical strengthening of the scheme.
To strengthen the scheme, a comprehensive guideline and SOP are being prepared. A foolproof system is being developed, including the formation of an Anti-Fraud Unit comprising experts in IT, claim audit, medical audit, and surveillance.
Additionally, a Grievance Redressal Cell will be set up for quick resolution of complaints related to the scheme. A centralised complaint resolution centre will be established at the state level, and an online complaint tracking system will be developed. At the district level, too, complaint redressal units will be created.
Suspicious doctors, pharmacies, and hospitals are being closely monitored. If fake prescriptions or bills are found, the beneficiary’s membership may be suspended or cancelled. Technological measures such as e-prescription, e-billing, and real-time monitoring have been introduced. Regular audits and surprise inspections are being conducted. Hospitals and pharmacy stores found guilty will be removed from the scheme in the future, and legal action will be taken. (ANI)

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