Despite health minister Dr Deepak Sawant, agreeing that the third party administrator (TPA) had charged a huge commission and would be replaced while implementing the new scheme, the Rajiv Gandhi Jeevandayee Arogya Yojana Society (RGJAY) administration maintained that there was no scam in the health department. However, it did not reply when asked why the insurance company paid commission to the TPA from the state exchequer.
The RGJAY was started in seven districts on July 2, 2012, initially on pilot basis and later implemented across the state. As per the agreement signed between the state government and national insurance company (NIC), it was to provide health insurance to 9.75 crore people from 2.20 crore families belonging to Above Poverty Line (APL) and Below Poverty Line (BPL).
According to RGJAY society’s clarification, NIC, a public sector undertaking (PSU), was appointed by the state government through tender process to implement the scheme. NIC appointed three TPAs, including MDIndia Healthcare Services, Medi Assist India, and Paramount Health Services to perform various functions like claims scrutiny, hospital empanelment, field operations etc.
The RGJAY society was formed to carry out the overall supervision and monitoring of the scheme. NIC, after mutual discussion with the state government, agreed to keep per family, per annum, premium of Rs 333 as per the first phase. So, the NIC was appointed and continued to implement the scheme even in the second phase.
The administration said that as per the MoS signed between RGJAY society and NIC, the insurer appointed TPAs. The society said that till date, 855,350 surgeries or therapies had been performed under the RGJAY scheme and the society had paid Rs 2350.02 crore, including service tax and 20 per cent administration cost as premium amount to NIC. Total claims paid cases were 739,479, amounting to Rs 1675.01 crore as premium payment and RGJAY Society had paid 20 per cent i.e. Rs 470 crore with service tax as administrative cost to NIC.
Kishor Tiwari, president of Vasantrao Naik Shetkari Swavalamban Mission, complained to the chief minister that the TPA had siphoned off '500 crore while NIC questioned why the RGJAY society was keeping mum on the missing amount from paid premium.
“When Dr Sawant has agreed that the commission is high, why is RGJAY society shielding them Is there any nexus between the insurance provider, TAPs and staff of RGJAY society ” Mr Tiwari asked.
