Ayushman Bharat Scheme Current Affairs - 2020

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171 Hospitals de-empanelled under Ayushman Bharat Scheme

On January 3, 2020, around 171 hospitals were de-empanelled by Ministry of Health and Family Welfare for committing fraud. The Ministry had also imposed a fine of Rs 4.5 crores. The FIRs were lodged on 6 hospitals in Uttarakhand and Jharkhand states.

Highlights

The Anti-Fraud units detected fake e-cards and lodged FIRs in the corresponding states. It is the responsibility of the sate health agency to create an e-card and add additional family member under the scheme if any. The Anti-Fraud Unit detected that the private hospitals were fraudulently performing these government reserved procedures.

Earlier similar cases were detected by the unit in Chhattisgarh, Madhya Pradesh and Punjab and penalties were imposed.

Anti-Fraud Units

The Anti-Fraud Units operate under the guidelines provided by National Health Agency operating under Ministry of Health and Family Welfare.

National Health Agency

The National Health Agencies were set up in order to implement India’s flagship scheme “Ayushman Bharat”. The National Health Authority is the successor of National Health Agency.

Ayushman Bharat

The scheme aims at covering 10 crore poor families providing health coverage of 5 lakh rupees per family. The scheme is recently being criticized widely for the increased fraudulent activities by private hospitals. At least 697 fake cases have been registered in Uttarakhand alone. However, the scheme unlike its previous scheme Rashtriya Swasthya Bhima Yojana uses robust IT infrastructure to locate suspicious surges.

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20 States sign MoU for implementing Ayushman Bharat – National Health Protection Mission

Twenty States have signed Memorandum of Understanding (MoU) with Union Ministry of Health and Family Welfare (MoHFW) for implementing Ayushman Bharat-National Health Protection Mission (AB-NHPM). The MoUs were exchanged during Health Ministers’ conclave held in New Delhi. During the conclave, aspects of NHPM, like operational guidelines, model tender document for selection of insurance companies and implementation support agencies for trusts were discussed.

Ayushman Bharat-National Health Protection Mission (AB-NHPM)

AB-NHPM aims to target over 10 crore families belonging to poor and vulnerable population based on Socio Economic and Caste Census 2011 (SECC) database. It will cover of Rs 5 lakh per family per year, taking care of almost all secondary care and tertiary care procedures. There will be no cap on family size and age in the scheme. The scheme integrates two on-going centrally sponsored schemes viz. Rashtriya Swasthya Bima Yojana (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS).

Benefit cover: It includes pre and post-hospitalisation expenses. It will cover all pre-existing conditions from beginning of the policy. It will also pay defined transport allowance per hospitalization to the beneficiary.

Cashless benefits: The scheme allows the beneficiary to take cashless benefits from any public or private empanelled hospitals across the country. The payment for treatment will be done on package rate which will be defined by Government in advance basis. The package rates will include all the costs associated with treatment.

Role of state governments: They are allowed to expand the scheme both horizontally and vertically. They are also free to choose modalities for implementation. They can implement through insurance company or directly through Trust/ Society or a mixed model. States/UTs will have also flexibility to modify these rates within limited bandwidth.

Council: For giving policy directions and fostering coordination between Centre and States, Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) will be set up at apex level. It will be chaired by Union Health and Family Welfare Minister.

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