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$adminprix = 'admin' $rn = object(App\Model\Entity\Article) { 'id' => (int) 17645, 'title' => 'Private hospitals perform fake surgeries to claim thousands in insurance cover -Dheeraj Tiwari', 'subheading' => '', 'description' => '<div style="text-align: justify"> -The Economic Times </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> Nazia is 10 years old. But, according to a claim filed by Chhattisgarh-based Shaheed Hospital with the Rashtriya Swasthya Bima Yojna (RSBY), she has delivered a baby after a caesarean operation. Mukul (name changed) is only 7. But Agarwal Hospital, Raipur, has made a claim for removing cataract from his eyes. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> A large number of similar implausible claims, being made by private hospitals enrolled to treat poor patients under the RSBY scheme, have prompted the finance ministry to advise public sector insurers to exercise greater vigilance. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> The hugely popular RSBY is the country's largest health insurance scheme covering 32.4 million poor families. About 7,000 private hospitals like Shaheed Hospital are enlisted to help treat poor patients and are reimbursed by the scheme. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> A finance ministry letter to insurers listed examples of such false claims, including a two-year-old delivering a baby and a four-year-old undergoing a cataract operation. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> Several private hospitals and nursing homes in Bihar and Chhattisgarh, among other states, have been reportedly performing unnecessary or fictitious surgeries to claim up to 30,000 in insurance cover available to each RSBY cardholding family. The government has de-empanelled 260 hospitals found to be indulging in similar malpractices, according to the labour ministry. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> <em>Insurers Must Strengthen Audit</em> </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> "The abnormally high number of such cases has been pointed out. We have directed insurance firms to look into the issue," said a finance ministry official, who did not wish to be named. The ministry has also directed all four public sector general insurance firms to strengthen their audit and review the performance of the third-party administrators, or TPAs, involved. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> "We have received a letter from the ministry asking us to look into the issue and take corrective actions," the chief of a state-run general insurance firm told ET on the condition of anonymity. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> So far, four million claims have been made under the RSBY scheme, which covers an estimated 161.7 million persons below poverty line. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> Launched in April 2008, the scheme, implemented by the labour ministry, aims to provide an annual health insurance cover of 30,000 each to BPL families and a few categories of unorganised sector workers. There are about 11,000 hospitals empanelled under the scheme. The government had increased the allocation for the scheme from 360 crore to 1,500 crore in the 2012-13 Budget. RSBY's claim ratio is still lower than other comparable or government schemes, but a recent spurt in claims has raised the alarm. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> The scheme has processed 1.65 million claims since its inception, paying out claims worth a cumulative 700 crore. Of this, 400 crore was paid out in the six months from October 2010 through March 2011 alone, indicating the rapid growth. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> RSBY's claim ratio of 66.8% compares favourably with the 89% recorded by Andhra Pradesh's Rajiv Aarogyasri Community Health Insurance Scheme. It is also better than the 92% claim ratio registered by government health insurance schemes in 2010-11. Other group health insurance schemes had a claim ratio of 107% while for individuals, it was 87%. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> "The claim ratio will be higher in group health and individual health schemes because these schemes are urban centric. So the incidence of more people availing medical facilities will be higher compared with rural areas. Secondly, there is a vast cost differential between the cost of medical treatment," a finance ministry official explained. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> Insurers say RSBY alone cannot be blamed for such unfair practices. "It may have some flaws, but at the end it is providing healthcare facilities to the poorest of the poor. As far as unnecessary claims are concerned, hospitals are the biggest culprits," said a general manager with a private sector general insurance firm. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> Such instances of false claims could be a roadblock for the scheme, which has the potential to improve the infrastructure of the healthcare system in the country that could not be done in the last 60 years, says Sabahat Azim, director of Glocal Healthcare, a low-cost hospital chain backed by former Sebi chairman M Damodaran, Sequoia Capital and Elevar Equity. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> "Quality comes from supply. 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$adminprix = 'admin' $rn = object(App\Model\Entity\Article) { 'id' => (int) 17645, 'title' => 'Private hospitals perform fake surgeries to claim thousands in insurance cover -Dheeraj Tiwari', 'subheading' => '', 'description' => '<div style="text-align: justify"> -The Economic Times </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> Nazia is 10 years old. But, according to a claim filed by Chhattisgarh-based Shaheed Hospital with the Rashtriya Swasthya Bima Yojna (RSBY), she has delivered a baby after a caesarean operation. Mukul (name changed) is only 7. But Agarwal Hospital, Raipur, has made a claim for removing cataract from his eyes. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> A large number of similar implausible claims, being made by private hospitals enrolled to treat poor patients under the RSBY scheme, have prompted the finance ministry to advise public sector insurers to exercise greater vigilance. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> The hugely popular RSBY is the country's largest health insurance scheme covering 32.4 million poor families. About 7,000 private hospitals like Shaheed Hospital are enlisted to help treat poor patients and are reimbursed by the scheme. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> A finance ministry letter to insurers listed examples of such false claims, including a two-year-old delivering a baby and a four-year-old undergoing a cataract operation. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> Several private hospitals and nursing homes in Bihar and Chhattisgarh, among other states, have been reportedly performing unnecessary or fictitious surgeries to claim up to 30,000 in insurance cover available to each RSBY cardholding family. The government has de-empanelled 260 hospitals found to be indulging in similar malpractices, according to the labour ministry. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> <em>Insurers Must Strengthen Audit</em> </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> "The abnormally high number of such cases has been pointed out. We have directed insurance firms to look into the issue," said a finance ministry official, who did not wish to be named. The ministry has also directed all four public sector general insurance firms to strengthen their audit and review the performance of the third-party administrators, or TPAs, involved. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> "We have received a letter from the ministry asking us to look into the issue and take corrective actions," the chief of a state-run general insurance firm told ET on the condition of anonymity. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> So far, four million claims have been made under the RSBY scheme, which covers an estimated 161.7 million persons below poverty line. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> Launched in April 2008, the scheme, implemented by the labour ministry, aims to provide an annual health insurance cover of 30,000 each to BPL families and a few categories of unorganised sector workers. There are about 11,000 hospitals empanelled under the scheme. The government had increased the allocation for the scheme from 360 crore to 1,500 crore in the 2012-13 Budget. RSBY's claim ratio is still lower than other comparable or government schemes, but a recent spurt in claims has raised the alarm. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> The scheme has processed 1.65 million claims since its inception, paying out claims worth a cumulative 700 crore. Of this, 400 crore was paid out in the six months from October 2010 through March 2011 alone, indicating the rapid growth. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> RSBY's claim ratio of 66.8% compares favourably with the 89% recorded by Andhra Pradesh's Rajiv Aarogyasri Community Health Insurance Scheme. It is also better than the 92% claim ratio registered by government health insurance schemes in 2010-11. Other group health insurance schemes had a claim ratio of 107% while for individuals, it was 87%. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> "The claim ratio will be higher in group health and individual health schemes because these schemes are urban centric. So the incidence of more people availing medical facilities will be higher compared with rural areas. Secondly, there is a vast cost differential between the cost of medical treatment," a finance ministry official explained. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> Insurers say RSBY alone cannot be blamed for such unfair practices. "It may have some flaws, but at the end it is providing healthcare facilities to the poorest of the poor. As far as unnecessary claims are concerned, hospitals are the biggest culprits," said a general manager with a private sector general insurance firm. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> Such instances of false claims could be a roadblock for the scheme, which has the potential to improve the infrastructure of the healthcare system in the country that could not be done in the last 60 years, says Sabahat Azim, director of Glocal Healthcare, a low-cost hospital chain backed by former Sebi chairman M Damodaran, Sequoia Capital and Elevar Equity. </div> <div style="text-align: justify"> <br /> </div> <div style="text-align: justify"> "Quality comes from supply. If more hospitals are set up because of the scheme, patients will have a choice," says Azim, a trained doctor and IAS officer, and earlier secretary to Tripura's chief minister. </div>', 'credit_writer' => 'The Economic Times, 24 October, 2012, http://articles.economictimes.indiatimes.com/2012-10-24/news/34708046_1_rsby-private-hospitals-labour-ministry', 'article_img' => '', 'article_img_thumb' => '', 'status' => (int) 1, 'show_on_home' => (int) 1, 'lang' => 'EN', 'category_id' => (int) 16, 'tag_keyword' => '', 'seo_url' => 'private-hospitals-perform-fake-surgeries-to-claim-thousands-in-insurance-cover-dheeraj-tiwari-17774', 'meta_title' => null, 'meta_keywords' => null, 'meta_description' => null, 'noindex' => (int) 0, 'publish_date' => object(Cake\I18n\FrozenDate) {}, 'most_visit_section_id' => null, 'article_big_img' => null, 'liveid' => (int) 17774, 'created' => object(Cake\I18n\FrozenTime) {}, 'modified' => object(Cake\I18n\FrozenTime) {}, 'edate' => '', 'category' => object(App\Model\Entity\Category) {}, '[new]' => false, '[accessible]' => [ '*' => true, 'id' => false ], '[dirty]' => [], '[original]' => [], '[virtual]' => [], '[hasErrors]' => false, '[errors]' => [], '[invalid]' => [], '[repository]' => 'Articles' } $imgtag = false $imgURL = 'The Economic Times, 24 October, 2012, http://articles.economictimes.indiatimes.com/2012-10-24/news/34708046_1_rsby-private-hospitals-labour-ministry' $titleText = null $descText = ' -The Economic Times Nazia is 10 years old. But, according to a claim filed by Chhattisgarh-based Shaheed Hospital with the Rashtriya Swasthya Bima Yojna (RSBY), she has delivered a baby after a caesarean operation. Mukul (name changed) is only 7. But Agarwal Hospital, Raipur, has made a claim for removing cataract from his eyes. 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