Bypassing Ayushman Bharat, doctor at top Central hospital duped patients, made killing on implants

Kumar’s example has played out in several cases. An investigation of official records, CBI court filings, and interviews with several doctors and patients by The Indian Express has pieced together how 54 patients were allegedly duped in the first three months of this year; how Rs 2.7 crore was collected for implants from mostly poor families over two years, including during Covid; and a nexus of middlemen and companies was used to route the money, including three where Rawat’s wife was a stakeholder.

Dr Manish Rawat

Ironically, many of these implants were covered under the Centre’s flagship Ayushman Bharat scheme. “Investigation has revealed that Dr Manish Rawat, in conspiracy… with others, did not allow the eligible patients to avail the benefits of Ayushman Bharat scheme of Government of India in order to take illegal money,” the chargesheet states.

When contacted, Dr Rawat’s defence counsel Naveen Kumar said his client is being falsely implicated by “certain individuals associated with Safdarjung Hospital”. Kumar said it is common for doctors to recommend vendors to patients from whom they can purchase medical implants. “In Dr Manish Rawat’s case, the vendors he was dealing with offered implants to patients at prices below the maximum retail price,” he said.

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This comes when the Centre’s flagship scheme covers an extensive network of over 27,000 empanelled hospitals. As of July 15, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana had recorded 5.37 crore authorised hospital admissions.

One of the most notable aspects of the scheme is that 57 per cent of the empanelled hospitals, which provide free treatment to beneficiaries, are public hospitals. This enables poor patients to confidently seek treatment with the faith that they will not be cheated of their due.

However, this case serves as a reminder of loopholes in the system.

In its chargesheet, the CBI looked at payments made by 94 patients in the first three months of this year, and gathered data of 54 being overcharged.

A detailed analysis of patient data by The Indian Express reveals glaring discrepancies between the actual cost of the implants and the amount allegedly charged to patients by Dr Rawat and his associates. In as many as 25 cases, the money allegedly received for implants were as much as 500% of the actual cost charged by the seller.

Consider these telling examples:

• On an average, patients paid Rs 48,833 for a medical implant, while the sellers received an average payment of Rs 11,604.

• Some cases are stark: One patient paid Rs 60,000 for an implant, while the seller got Rs 2,000; two other patients paid Rs 50,000 and Rs 49,000, while the corresponding payments to the seller were Rs 4,000 each; and in yet another case, the seller got Rs 2,000 while the patient had paid Rs 35,000 for an implant.

• In seven cases, the patient paid over Rs 1 lakh, resulting in an average overcharging of more than Rs 90,000. The highest amount charged from a patient was Rs 1.66 lakh, while the seller in this case got Rs 58,000.

The CBI intercepted 166 calls that revealed a list of patients with a code ‘Galle ki list’. They also accessed a ‘Patient Group’ on WhatsApp, where Dr Rawat and his associates allegedly posted and updated information about collection of money from patients or their attendants, and to whom the collected money was transferred. Records also include entries maintained by the proprietor of a surgical shop which provided the implants.

As per the chargesheet, WhatsApp conversations of the ‘Patient Group’ suggest that “all payments received from the patients were handed over” to Dr Rawat or his family members.

The CBI has pointed to a series of transactions directed towards three entities in particular: Jubilation Bio Science Pvt Ltd, Jubilation Business Services Pvt Ltd, and A&A Enterprises. Dr Rawat’s wife is a stakeholder in all three firms, The Indian Express has found.

It is alleged these entities received a total of Rs 29.06 lakh in the form of cash deposits from one of Dr Rawat’s associates, Avnesh Kumar Arya.

Arya, who was employed at Jubilation Bio Science Pvt Ltd till December last year and is named as a co-accused in the case, was unavailable for comment.

The CBI has alleged that Dr Rawat, with the help of Arya and one Manish Sharma, also a former employee of Jubilation Bio Science Pvt Ltd and another accused in the case, collected approximately Rs 2.7 crore from patients between February 26, 2021 and March 29, 2023.

The CBI chargesheet also details how relatives of patients were allegedly put in a spot by Dr Rawat’s accomplices, particularly in times of desperation.

Take the example of Girish Kumar Sinha, who came in suffering from tuberculosis meningitis and doctors began treating a build-up of fluid in cavities deep within the brain. He was admitted under the care of Dr Rawat on March 7.

According to the CBI, when Sinha’s health deteriorated, it was decided to insert an external ventricular device (EVD) in the ventricle to drain the fluid and release pressure in the brain. The CBI chargesheet states that despite shunts and EVD kits being readily available in the department of neurology free of cost for patients, Sinha’s relatives were kept in the dark.

Instead, the CBI alleges, Arya and Sharma, who were already present in the OPD room, informed Sinha’s son Ashish that his father needed an operation to implant a “shunt” in his brain. They demanded Rs 50,000 to cover the cost.

On March 8, Sinha’s condition worsened and he succumbed to his illness. “Investigation has revealed that Rawat in connivance and conspiracy with Arya and Sharma performed his public duty dishonestly in consequence of accepting an undue advantage from the patient and abused his official position as a public servant,” the CBI chargesheet states.

On the same day Sinha was admitted, one Ajeet Singh was brought to the casualty department before being referred to the department of neurosurgery under Dr Rawat’s care. An early spine operation was suggested and on March 10, 2023, a lateral mass and rod fixation procedure was performed.

According to the chargesheet, Dr Rawat introduced Arya as his personal assistant to Singh’s daughter Simran.

Arya proceeded to explain the availability of three different implants in the market – costing between Rs 50,000 and Rs 1 lakh, plus GST if she needed a bill. Simran eventually opted for the most expensive implant, paying Rs 1,15,500. However, the CBI has stated that the actual cost of the implant was only Rs 14,000.

Dr Rawat joined Vardhman Mahavir College and Safdarjung Hospital as an assistant professor in the Department of Neurology in June 2016. He was promoted to the position of associate professor by the Union Health Ministry in November 2022. Prior to his tenure at the college and hospital, Dr Rawat had been practising at various private hospitals in Bareilly. According to investigators, it is in Bareilly that Dr Rawat met Arya in 2014.

Safdarjung Hospital, where the alleged crimes took place, is a prominent and bustling tertiary-level, multidisciplinary healthcare institute operated by the Centre. Recognised for its scale and capacity, it serves a substantial population of underprivileged and marginalised individuals, addressing their critical healthcare requirements.

While operations at Safdarjung Hospital are free of charge, patients undergoing neurosurgery procedures are responsible for procuring any cranial or spinal implants required for their treatment. However, individuals covered under the Ayushman Bharat Scheme are eligible to have the costs of these implants fully covered.

Within the hospital, the emergency department is among the busiest sections, witnessing a footfall of more than 1,000 patients every day. The CBI has alleged that Dr Rawat instructed senior residents to compile a list of patients admitted to the emergency ward. Following this, his two associates would impersonate personal assistants and inform patients that surgical implants needed to be obtained externally. It is also alleged that Dr Rawat used to provide slips to patient attendants in the neurosurgery OPD. These slips allowed them to get in touch with his associates in order to arrange implants from the outside, the CBI has alleged.

According to sources, just days after Dr Rawat’s arrest, a three-member technical committee was formed by the then Medical Superintendent with the purpose of investigating the procurement of implants from external sources for surgeries. The committee’s objective, sources said, is to address situations where these implants were not readily available within the hospital and to assist patients in obtaining them at a reasonable cost.

The aim is to establish a system where no direct transactions occur between doctors and patients regarding the procurement of implants, sources said, adding that an MoU between the hospital and the government pharmacy is under process.

“Under this proposed arrangement, patients who require implants for their surgeries will deposit the necessary funds directly into the account of Safdarjung Hospital MS. Subsequently, Amrit Pharmacy will supply the required implants to the respective doctors. The cost of these implants will be reimbursed to Amrit Pharmacy’s account,” sources said. Dr Vandana Talwar, the Medical Superintendent at Safdarjung Hospital, was unavailable for comment on the systems that were put in place following Rawat’s arrest.