Rs 1.43 crore paid for treatment of ineligible people
Moreover, premium of Rs 1.43 crore was paid against ineligible beneficiaries.
MUMBAI: The Comptroller and Auditor General (CAG) has pulled up the state government for alleged irregularities in the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY). The CAG pointed out that after paying insurance of Rs 3,009.31 crore for 9.35 crore people, only 11.89 lakh claims have been received. The CAG blamed it on poor publicity given to the scheme.
Moreover, premium of Rs 1.43 crore was paid against ineligible beneficiaries. The insurer has not refunded the amount to the government, the CAG pointed out.
As against a premium of Rs 3,009.31 crore paid to the insurer company till November 2016 covering 9.35 crore beneficiaries, a meagre 11.89 claims were received due to the absence of adequate publicity, shortfalls in conducting health camps and non-appointment of arogya mitras at primary health centres. The CAG said that the scheme benefits were notcommensurate with the expenditure incurred.
The CAG further said that the data of the beneficiaries had not been verified via audit and hence, it was difficult to understand the benefits of the scheme.
The CAG report said, “The audit of the Rajiv Gandhi Jeevandayee Arogya Yojana as implemented in the state has revealed that the government/society obtained the data of the total number of ration card holders without any details such as name and ration card number. Therefore, the correctness/authenticity of the beneficiaries covered under the scheme could not be verified in the audit.”
“Besides, an excess premium of Rs 1.43 crore paid to the insurer against ineligible beneficiaries had not been refunded by the insurer company. A huge balance of surplus premium of Rs 47.63 crore was lying with the insurer company which was due for remittance to the government. The insurer company had also got double benefit of Rs 8.75 crore due to further adjustment of 10 per cent of the surplus premium lying with it. Surplus funds of the claim money received by empanelled hospitals were lying with it,
since the society did not ensure return of these funds to the government account,” the report said.