BLATANT VIOLATIONS

India's flagship health insurance scheme for the poor remains riddled with irregularities and corruption, shows an audit by the Comptroller and Auditor General of India

- SHAGUN DELHI

ON AUGUST 8, the Comptroller and Auditor General of India (CAG) tabled a report in Parliament highlighting gross irregularities in the Centre's flagship universal health coverage scheme, Pradhan Mantri Jan Arogya Yojana (PMJAY).

From fake beneficiary accounts to the empanelment of ill-equipped hospitals, the country's nodal auditing agency found many challenges with the implementation of the scheme that provides an annual health cover of ₹5 lakh per family per year for hospitalisations through a network of public and empanelled private healthcare providers. The scheme, set to complete five years this September, promises cashless and paperless hospitalisation and treatment.

PMJAY has an aim of covering 107.4 million of the poorest households identified under the Socio-Economic and Caste Census (SECC) database. In reality, only 18.9 million or 17.5 per cent of the poorest households were registered until July 2021.

The report raises questions about the quality of the data used to identify the beneficiaries. National Health Authority (NHA), the implementing agency of the scheme, "has used SECC database of 2011 as eligibility criteria for the scheme. The database was more than seven years old at the time of inception of the scheme. Looking into economic development and employment opportunities since then, it cannot be denied that many households may have become ineligible for inclusion while others may have become eligible for the SECC under the existing criteria," the audit report reads.

Owing to the poor quality of the database, CAG could not trace 30 per cent of the beneficiaries. The beneficiary list also includes 110,000 government pensioners and their family members who cumulatively availed treatment worth *28.87 crore under the scheme.