UP Govt Seeks PG Doctors to audit Ayushman Bharat Reimbursement Claims
Lucknow: The Uttar Pradesh government, aiming to expedite the reimbursement claims process for hospitals empanelled under the Ayushman Bharat scheme, has requested government hospitals across the state to submit the names of postgraduate (PG) doctors who may be willing to volunteer as medical auditors.
These medical auditors will be responsible for reviewing and approving claims from hospitals once treatments for Ayushman Bharat beneficiaries are completed. The auditors will work on an incentive-based payment structure, receiving compensation for each claim they approve. The State Agency will make these payments for Comprehensive Health and Integrated Services (SACHIS), which oversees the operations of hospitals under the Ayushman Bharat scheme in the state. The work can be carried out through a work-from-home arrangement. This flexible option will encourage more doctors to participate in the auditing process.
Also Read: Rs 1.21 lakh Crore claims pending under Ayushman Bharat, reveals RTI
According to Hindustan Times, “The work of a medical auditor is done via online portal hence, the volunteer doctors can do it from their workplace or from home as well,” said Dr AP Singh, GM Medical Management, in a letter to all the superintendents of the government hospitals.
The move is part of an ongoing effort to streamline the reimbursement process under the Ayushman Bharat scheme, which aims to provide free healthcare coverage of up to Rs. 5 lakh for each beneficiary family. Uttar Pradesh currently has 5,854 hospitals impaneled with the Ayushman Bharat scheme. Over the past 30 days, SACHIS has cleared claims amounting to Rs. 407 crores for impaneled hospitals under the scheme.
Also Read: Rs 562.4 crore fake claims under AB-PMJAY: 1,114 Hospitals de-empanelled, 549 suspended
Medical dialogues had previously reported that, according to the National Anti-Fraud Unit (NAFU) investigation, out of Rs 6.66 crore claims processed under the Ayushman Bharat-PM Jan Arogya Yojana (AB-PMJAY), nearly 2.7 lakh claims from private hospitals were found to be fraudulent.