It is a matter of crying shame that the Comptroller and Auditor General of India (CAG) has highlighted in the latest report on Performance Audit of Ayushman Bharat that overall, 7,49,820 beneficiaries were linked with a single mobile number (9999999999) in the Beneficiary Identification System (BIS) related to the scheme.
Besides, 1,39,300 beneficiaries were linked to the phone number 8888888888; and 96,046 others linked to the number 9000000000.Additionally, there were at least 20 cell phone numbers to which between 10,001 and 50,000 beneficiaries were linked. As per the report, 7.87 crore beneficiary households were registered, constituting 73% of the targeted 10.74 crore households (as of November 2022). Later, the government increased the target to 12 crore.
According to the report, many pensioners in Chandigarh, Haryana, Himachal Pradesh, Karnataka, Maharashtra, and Tamil Nadu were found possessing PMJAY cards and availing treatment under the scheme.
The AB-PMJAY, world’s largest health assurance scheme, guarantees cashless secondary and tertiary inpatient care for a wide range of health conditions to its beneficiaries. It provides a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to more than 12 crore families, constituting the bottom 40 per cent of the population. Launched in September 2018, the scheme is expected to take India closer to the UN Sustainable Development Goal 3.8, which envisions universal health coverage.
About 15.5 crore families are covered under AB-PMJAY and states’ schemes being implemented in convergence with it. Eleven States/UTs have pushed for 100 per cent coverage of their respective population.
The Ayushman Card related to the AB-PMJAY scheme is like a pre-paid card worth Rs 5 lakh, which can be used to avail free treatment at more than 27,000 empanelled hospitals. More than 24 crore Ayushman Cards have reportedly been created. Of course, covering every possible beneficiary with an Ayushman Card is still a tall order, though a person on the beneficiary list is not supposed to be denied service if she does not have a card. As per official data, the scheme has catered to more than 5.39 crore admission events worth Rs 66,284 crore over the past five years.
A key feature of AB-PMJAY is inter-state portability. That is, a patient registered in one state is entitled to receive care in any other state that has an AB-PMJAY programme. This feature has proved helpful to migrants, especially in emergencies.
The CAG has identified several glaring irregularities in the registration and validation of beneficiaries.”Data analysis of the BIS database revealed that there were large numbers of beneficiaries registered against the same or invalid mobile number. Overall, 1,119 to 7,49,820 beneficiaries were linked with a single mobile number in the BIS database…,” the report states, in a damning indictment of the Centre’s flagship health scheme.
Reflecting serious loopholes in the BIS, the report noted: “Mobile numbers are significant for searching records related to any beneficiary in the database, who may approach the registration desk without the ID. In the case of loss of e-card, identification of the beneficiary may also become difficult. This may result in denial of scheme benefits to eligible beneficiaries as well as denial of pre- and post-admission communication causing inconvenience to them.”
The National Health Authority (NHA) is not blind to the aberrations in BIS. ‘Chaltha hai’ seems to be the only performance metric. “The NHA, while agreeing with audit observation, stated (August 2022) that with the deployment of BIS 2.0, this issue shall be resolved,” the CAG placed on record. Further, the BIS 2.0 system has reportedly been reconfigured in such a manner that more than a certain number of families cannot use the same mobile number.
As per the report, though ‘Beneficiary Empowerment Guidebook’ provides that for communication with the beneficiary from admission in hospital to post-discharge feedback, contact number will be used, and the guidelines on disabling a BIS e-card provide that the SHA shall send SMS intimation to the contact number provided at the time of card creation informing the beneficiary to check their eligibility, data analysis of the BIS database revealed that there were large numbers of beneficiaries registered against the same or invalid mobile number.
Shockingly, the report revealed that in 43,197 households, the size of the family ranged from 11 to 201 members. “Presence of such unrealistic members in a household in the BIS database indicates not only lack of essential validation controls in the beneficiary registration process, but also the possibility that beneficiaries are taking advantage of the lack of a clear definition of family in the guidelines,” the report observes.
The NHA also stated that the National Anti-Fraud Unit has sent periodic reminders to the States/UTs highlighting discrepancies in verified data. Since ‘Public Health’ is a State subject, the final decision in this regard vests with the State governments.
Officially speaking, service delivery under AB-PMJAY is supposed to be digitised end-to-end, obviating systemic bias. Apart from an internal monitoring system, NHA is supposed to have deployed a public dashboard where the scheme’s implementation, on a day-to-day basis, could be tracked. Details of people who have availed treatment under the scheme can be published without compromising their privacy.The claim processing is, on record, completely faceless. But when faceless babus preside over the system at key points of intervention, the lapses of the kind highlighted by the CAG cannot be avoided.
Considering the abject failure of the subsystems designed for real-time monitoring and the in-your-face loopholes in BIS, the National Anti-Fraud Unit (NAFU — which designs, implements and oversees anti-fraud initiatives) must work closely with Anti-Fraud Units at the state level and make the system robust and fool-proof.
Apart from mandating Aadhaar-based authentication for card creation and registration for treatment, the NHA is supposed to be using Artificial Intelligence and Machine Learning technologies to detect suspicious transactions/potential frauds. The CAG’s sickening findings must be an eye-opener to the NHA. It is obvious that its desk and field audits (including surprise ones) were eyewash, if not deliberate exercises in futility.
