The Ayushman Bharat PMJAY scam in Chhattisgarh has come under the national spotlight, exposing widespread fraud by private hospitals. The state now ranks second in the country for the highest number of fraudulent claims under the Pradhan Mantri Jan Arogya Yojana (PMJAY). From inflated bills to fake procedures, several private institutions have manipulated the system, siphoning off crores of rupees while depriving real patients of quality healthcare.
Recent data from the National Health Authority (NHA) reveals that Chhattisgarh ranks second among all Indian states in terms of PMJAY-related fraud, right after Uttar Pradesh. From fake surgeries to ghost patients, the abuse is systemic and growing.
🚨 How Private Hospitals in Chhattisgarh Are Gaming the System
Investigations and audits have revealed multiple forms of fraud and malpractice by private hospitals in Chhattisgarh:
1. Fake Surgeries in Dhamtari
A private hospital in Dhamtari claimed reimbursements for performing laparoscopic hysterectomies on women who never underwent surgery. Upon inspection, patients had no scars or surgical history. The hospital was later blacklisted.
2. Bogus Cardiac Procedures in Bilaspur
A Bilaspur-based hospital billed the scheme for angioplasties and stent implants—yet had no cardiac lab or proper infrastructure. Claims worth lakhs were fabricated using fake documents. The hospital was removed from the PMJAY panel.
3. Ghost Patients in Raipur
In Raipur, middlemen helped hospitals obtain PMJAY cards from slum dwellers, then used them to file fraudulent claims for treatments never rendered. The scam exposed over ₹1 crore in fake bills, leading to multiple FIRs and arrests.
4. Duplicate Claims in Rajnandgaon
Multiple hospitals submitted claims for the same patient within short time spans, with conflicting diagnoses and treatment dates. Advanced audits using timestamps and GPS data revealed the fraud. Thousands of past claims were flagged for review.
🧍♀️ Real Case: How PMJAY Saved Mohana Bai – But Not Without Struggles
Amid the alarming fraud statistics, stories like that of Mohana Bai from Durg district show how PMJAY can still change lives—if patients can navigate the system.
In December 2024, 56-year-old Mohana Bai began suffering from severe breathlessness. Her daughter, Nisha Kewat, rushed her to three different hospitals in Durg—all empaneled under PMJAY—but none had the resources to treat cardiac issues. After days of delay and rising panic, she reached SMC Heart Hospital in Raipur.
There, doctors diagnosed a serious heart condition requiring immediate care. Fortunately, SMC accepted the PMJAY card, and Mohana received treatment free of cost. The procedure, which would have cost tens of thousands of rupees, was completely covered.
However, the journey revealed deeper issues:
- Lack of infrastructure in semi-urban hospitals.
- No clear referral guidance, causing life-threatening delays.
- Poor awareness of the scheme among beneficiaries like Nisha.
While the outcome was positive, the experience underscored how implementation gaps can make or break outcomes under Ayushman Bharat.
🔍 What’s Being Done to Fix It?
Recognizing the rising fraud, both the Chhattisgarh government and the National Health Authority have taken key steps:
- Blacklisting of fraudulent hospitals across Raipur, Dhamtari, and Bilaspur.
- AI-based claim monitoring and biometric checks for identity verification.
- Audits of high-value and frequent claims to identify suspicious patterns.
- Awareness drives among PMJAY beneficiaries to prevent manipulation.
But experts agree: unless district-level monitoring is significantly improved and hospital empanelment is tightened, fraud will remain a persistent threat.
✅ Conclusion: A Scheme Full of Potential, but Vulnerable to Exploitation
The Ayushman Bharat PMJAY scam in Chhattisgarh reveals how private hospitals can exploit even the best-intentioned welfare programs. Yet, stories like Mohana Bai’s show there is still hope—if the scheme is managed transparently, monitored effectively, and empowered by technology.
To truly fulfill its promise, PMJAY must shift from being a paper entitlement to a trustworthy, accessible safety net—especially for rural and marginalized families who need it most.
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