A male patient’s diagnosis of prostate cancer conducted by a gynaecologist, an application seeking Rs 1 lakh submitted by a “proxy” unknown to the patient, and a doctor admitting that he was “under pressure to give an inflated estimate”.
An investigation by The Indian Express, based on documents accessed under the Right to Information (RTI) Act, has found how healthcare providers in Maharashtra obtained funds from the Chief Minister’s Relief Fund (CMRF), a popular and well-intentioned scheme to help the poor meet their medical expenses, by fudging records and inflating costs.
On Monday, The Indian Express reported on how cash was deposited from the charity fund last June for the treatment of a patient who had died 21 days ago and dubious certificates were used to claim benefits in other cases. Reacting to these findings, Chief Minister Devendra Fadnavis promised strict action against those fraudulently claiming benefits.
The RTI documents show several instances of regulatory lapses, including the case of Raghunath Gade, a 58-year-old man from Gadewadi in Beed, who was sanctioned Rs 1 lakh for prostate cancer treatment. But the diagnosis was conducted by Dr Asha Hodage, a gynaecologist at the Hake Hospital, an infertility and laparoscopy centre, which provided an estimate of Rs 3 lakh for a surgery, records show.
According to documents, the application was certified by the Medical Superintendent of the state-run St George Hospital in Mumbai, following which the money was deposited in the hospital’s official bank account. The phone number listed in the application form for Gade turned out to be wrong.
When contacted, Dr Asha Hake, owner of Hake Hospital, directed all queries to the Chief Minister’s Office (CMO) and refused to provide further details.
The RTI records also show that the CMO cleared payments of Rs 2.63 crore for 294 cases of stem-cell treatment for three years from November 2014. On September 26, 2017, an official scrutiny committee pointed out that “medical ethics were not adhered to” in several cases. On November 17, it noted that the Indian Council of Medical Research (ICMR) had termed the use of stem cells in patients outside an approved clinical trial as a “malpractice” — the CMO later discontinued the grant of funds under this category.
The records, moreover, reveal the vast difference between estimates and actual cost of treatment in many cases for which funds were obtained under the CMRF. When contacted, senior officials confirmed that while the Centre and state have issued an exhaustive rate list for medical procedures under government-funded schemes, it wasn’t considered for approvals under CMRF, which is managed by a trust.
Consider this official noting in the case of Pune resident Balu Hirnawale: “Diabetic? But MLA requested to give some help.” Submitted to the CMO on June 17, 2017, the application seeking funds to treating a diabetic foot infection at the Deshmukh Nursing Home in Pune was recommended by Rashtriya Samaj Paksha (RSP) MLA Rahul Kul, show documents.
The application included a treatment estimate from the nursing home of Rs 2 lakh, which was endorsed by the Medical Superintendent of state-run Sassoon Hospital.
When contacted, Dr Manisha Deshmukh, who owns the nursing home, said the final bill had come up to only Rs 39,000, and that the CMO had sanctioned Rs 40,000 under CMRF. “At one point, we felt his leg would have to be amputated. But his wound healed after multiple procedures,” said Deshmukh.
‘Under pressure to inflate estimates’
In another case, responding to the findings of this investigation, a doctor confirmed on record that he was “under pressure” to inflate cost estimates.
Records show that Aashirwad Hospital in Badlapur submitted an estimate of Rs 1.1 lakh under the scheme for an implant removal procedure to be conducted on a patient identified as Suryakant Mhaskar. The application was accepted by the CMO, which deposited Rs 50,000 in the hospital’s account, records show.
When contacted, Dr Vilas Dongre of Aashirwad Hospital confirmed that the final bill was for Rs 36,000. “I was under some pressure to give an inflated estimate,” he claimed, adding that the remaining Rs 14,000 was handed over to the patient.
When it was pointed out that unutilised funds under CMRF had to be returned to the CMO under rules, Dongre said, “I wasn’t aware of the norm.”
When contacted, the patient, Mhaskar, claimed: “I used the money to procure medicines.”
Highlighting the lack of adequate safeguards, records show that Mhaskar’s application was filled up by Walter Rodriquez, a resident of Kurla in Mumbai, who admitted that he did not know the patient. “A friend in Mantralaya asked me to sign on the application, which I did,” said Rodriquez, who claimed to be a social worker.
On June 26, 2017, the CMO received an application from Satara resident Tukaram Solavande, with an estimate of Rs 3.5 lakh from Vitthal Hospital in Pune for a craniotomy. On June 22, Bhanudas Madane, also from Satara, submitted an estimate from the hospital of Rs 3.8 lakh for a similar procedure.
When contacted, Dr Yuvraj Ghatule, partner, Vitthal hospital, confirmed that the actual cost was only Rs 1.46 lakh in the first case, and Rs 1.65 lakh in the second. The CMO finally sanctioned Rs 1 lakh each in both cases.
However, records also show that in both cases, the hospital’s estimate was submitted on undated letterheads with the same phone number provided for both patients — the number turned out to be incorrect.
“There is often a lot of pressure from the patient’s relatives to quote higher estimates. On humanitarian grounds, we sometimes agree to hike estimates by Rs 20,000-Rs 30,000,” said Ghatule.
The cases of inflated costs include that of Sanjay Jadhav, a professional wrestler from Kolhapur who injured his left knee during a match in January 2016. He approached Sportsmed Mumbai Pvt Ltd (SMPL) for a knee reconstruction surgery, which provided an estimate of Rs 3-3.2 lakh in the CMRF application.
When contacted, Dr Anant Joshi, director, SMPL, confirmed that the procedure had cost Rs 1.01 lakh. “The doctor who treated him is not associated with us anymore. In a multiligamentous injury, it sometimes becomes difficult to estimate the right cost… but normally the deviation isn’t as high as 200 per cent,” said Joshi.
Speaking to The Indian Express, Praveen Pardeshi, Additional Chief Secretary to the Chief Minister, said that a standard format for submitting treatment estimates and granting approvals has now been introduced.
The move followed recommendations by the CMRF scrutiny committee, which was set up by Fadnavis on September 7, 2017. Between November 1, 2014 and September 30, 2017, RTI records show that nearly Rs 237 crore was granted from the CMRF for medical expenses of poor patients in 23,267 cases.