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Saturday, February 27, 2021

Dead get cash, bills are fudged: Maharashtra financial assistance scheme for poor is ailing

Maharashtra CM’s office upgrades budget to help patients but glaring gaps in implementation: Records show how applicants and staff took Govt for a ride.

Written by Sandeep A Ashar | Mumbai |
Updated: February 27, 2018 2:36:42 pm
An applicant exits the Chief Minister’s Relief Fund cell in Mantralaya, Mumbai. (Express Photo/Ganesh Shirsekar )

On June 17 last year, Maharashtra Chief Minister Devendra Fadnavis’s office deposited Rs 90,000 in the official bank account of a heart hospital in Mumbai. Sanctioned under the Chief Minister’s Relief Fund (CMRF), a popular financial assistance scheme of the state government, the money was for the treatment of Ashok Pandurang Bhosle, a 45-year-old resident of Ahmednagar.

There was one problem, though.

An investigation by The Indian Express, based on documents obtained under the RTI Act, show that no one bothered to verify the patient’s status while depositing the money. Bhosle had died on May 27, 2017 — 21 days before the money for his treatment was deposited. The application  for assistance in his name was submitted on June 6 — 10 days after his death.

Read | Scheme popular, won’t tolerate misuse: CM Fadnavis

The investigation found how a well-intentioned scheme to help the poor was being corrupted during the implementation stage, with stolen identities, fake records, proxy applicants, inflated medical estimates and dubious income certificates being used to claim benefits.

It also showed that the Medical Assistance Cell (MAC) in the Chief Minister’s Office (CMO) continued to approve funds to hospitals across the state even after red flags were raised by a senior official linked to the scheme.

The findings assume relevance and significance at a time when the national rollout of a flagship health insurance scheme for the poor is being worked out by the central government in association with states.

A letter from CM’s office says Rs 90,000 was deposited to Potdar Heart Foundation’s account for the treatment of Ashok Bhosle on June 17, 2017 — 21 days after his death. (Express Photo)

RTI records show that between November 1, 2014 and September 30, 2017, the Maharashtra government spent more than Rs 237 crore from the CMRF to pay for the medical expenses of patients classified as “poor” in 23,267 cases. The Indian Express focused on 150 cases in which there were instances of irregularities from documents linked to 1,500 cases that were made available.

The investigation found:

* Several healthcare providers tweaked records and cost estimates to claim funds.

* CMRF norms state that assistance is only meant for life-threatening emergencies, but funds were sanctioned for fractures, infections and even convulsions triggered by alcoholism.

* Funds were provided for treatment red-flagged by the Indian Council of Medical Research (ICMR), such as use of stem cells without approved clinical trials.

* Applicants with substantial assets and known businesses availed benefits under CMRF by furnishing income certificates that classified them under Economically Weaker Section (EWS).

* Multiple applications from the same patients for the same treatment were cleared in violation of norms which specify that aid can be sanctioned only once in three years for one case.

Asha Suryavanshi was sanctioned Rs 40,000 on December 7, 2015, for a heart procedure at the Ashwini Sahakari Rugnalaya Ani Sanshodhan Kendra Niy in Solapur. But a probe found that she had been to the hospital only once —as an outpatient for a diagnostic test (see bill above) on September 21, 2015. (Express Photo)

Take the case of Bhosle, who died at the Potdar Heart Foundation’s hospital in Chembur. The application for assistance was recommended by BJP’s Mumbai MLA Ram Kadam. It included an income certificate, issued by Kurla’s Nayab Tahsildar on June 3, 2017, listing Bhosle’s current residential address at a chawl in Kurla.

But when contacted, Bhosle’s widow, Sangeeta, confirmed that the family had relocated to Ahmednagar around 10 years ago. “We were in Mumbai for my brother’s wedding. My husband was rushed to the hospital on the morning of May 27 last year, after he complained of chest pain. He died that evening,” she said.

There were other irregularities in the application form, which went undetected. The mobile number listed under Bhosle’s name was that of an accountant at the hospital.

When contacted, Potdar hospital’s medical director, Dr Ashwini Upadhyaya, admitted that Bhosle’s application had been submitted after his death, and that the CMO was not informed that the patient had died.

“We had to perform an urgent angioplasty on him on the admission day itself. Hours later, he passed away. The family had deposited Rs 25,000 on admission, but the total bill was around Rs 1.15 lakh. As the family was poor, we decided not to recover the rest of the expenses from them,” she claimed.

When contacted, MLA Kadam’s personal assistant, Sachin Ayare, said they “didn’t know that the patient had already died”.

Government officials confirmed that the hospital finally refunded the entire amount to the CMO on December 16, 2017 — after The Indian Express had first contacted Potdar for a response.

Documents accessed by The Indian Express also include the case of Asha Suryavanshi who was sanctioned Rs 40,000 on December 7, 2015, for a heart procedure — balloon mitral valvotomy — at the Ashwini Sahakari Rugnalaya Ani Sanshodhan Kendra Niy (ASARSKN) in Solapur.

But a probe report submitted by the District Collector to the CMO on February 3, 2016, said that Suryavanshi had been to the hospital only once — as an outpatient for a diagnostic test on September 21, 2015. It also found, documents show, that the medical records submitted with the application were “fabricated”.

When The Indian Express contacted the mobile number listed under Suryavanshi in the application form, it turned out to be invalid.

The Collector’s probe also found that two other cases of funds sanctioned for heart surgery at ASARSKN in 2015 were for procedures conducted three years ago, and in which patients had already paid the bills.

In a written communication to the government, ASARSKN’S Medical Superintendent Dr Rajendra Ghuli denied that the hospital had issued medical certificates or cost estimates for these applications. But following the probe, the CMO blocked the funds, said officials.

Documents also show that funds were sanctioned twice to the same patient within a month in violation of norms. Panvel resident Kiran Damodare was sanctioned Rs 1 lakh in two grants of Rs 50,000 each for treatment at Jupiter Hospital, Thane, for pelvic and femur fractures sustained during a road accident on November 19, 2015.

“The hospital estimated that we would need Rs 8.57 lakh. We weren’t satisfied with the Rs 50,000 sanctioned under the CMRF initially (on December 5, 2016). Some CMO officials asked us to apply again,” claimed Kiran’s younger brother Hrishikesh Damodare.

“After receiving a communication from the CMO that the funds had been released a second time (January 2016), we contacted the hospital. But they denied it,” he said.

When contacted, Anirudha Kulkarni, social worker attached to the hospital, said, “Our records show that the fund was received just once. We have communicated that to the patient’s family.”

Maharashtra, Devendra Fadnavis, Maharashtra Chief Minister Relief Fund, Maharashtra medical assistance scheme, Indian Council of Medical Research, hospitals in Maharashtra, corruption, indian express news The Maharashtra state secretariat in Mumbai. Officials say will initiate police action in cases of fraudulent claims. (Express Photo: Ganesh Shirsekar)

Government officials confirmed that the maximum assistance under CMRF for road trauma cases is Rs 50,000.

In another case, a Mumbai-based building contractor, who owns a house in Dombivali, was issued an EWS certificate on May 30, 2017, from the local tahsildar’s office, showing his family’s monthly income to be Rs 7,666. On June 5, 2017, his application was sanctioned Rs 1 lakh to fund his cancer treatment.

When contacted, the contractor’s daughter, who had submitted the application, said she was employed at a manager-level position in a well known private firm, and that she had been staying with her parents at the time. Asked how the EWS certificate was obtained, she disconnected the phone and did not respond to further requests for comment.

(Tomorrow: Inflated costs, distorted records)

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