Rajasthan's finance secretary (expenditure) Naveen Jain is on his way to tighten noose around private hospitals over their unreasonable and false claims under Rajasthan Government Health Scheme (RGHS), which is a health insurance facility for state government employees.
For that Jain has set up an artificial intelligence (AI) based Special Audit Cell, which monitors the bills submitted by private hospitals under the scheme. The audit cell reviews and assess bills on various parameters before clearing it.
The finance department has fixed stringent norms to detect wrong billing and identify fraudulent practices.
“Jain has been working on improving the system for last 6 months. There had been major frauds in RGHS in past. Now with improved system, there will be check on false billing,” said a senior officer of finance department.
Jain has also advised private hospitals to avoid unreasonable package booking. He said that several irregularities have been found in the claims being submitted by private hospitals.
“Some private hospitals are making mistakes in this scheme such as use of documents at more than one place, converting OPD to IPD against the rules, creating excessive bills unnecessarily and increasing the claim amount by conducting additional tests without need,” he said.
Jain pointed out that many hospitals have submitted claims with irregularities.
“We are taking this seriously and strong action including recovery, suspension and de-empanelment will be taken against those which are repeatedly submitting false claims in the name of minor mistakes,” he said.
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