CAG takes up audit of Ayushman Bharat

NEW DELHI: The Comptroller and Auditor General has taken up audit of the government’s flagship health scheme Ayushman Bharat that promises to provide health cover to the poor and vulnerable population. The scheme has so far insured more than 10 crore poor households in the country, covering a population of at least 50 crore under the universal health umbrella.
Ayushman Bharat was launched by PM Narendra Modi in September 2018 and has two components under it — PM Jan Arogya Yojana (PM-JAY) and Health and Wellness Centres (HWCs). The audit objectives include ascertaining the efficiency of the scheme, claims reimbursement to hospitals and if all poor households are included in the 10 crore families covered so far.
The PM-JAY, which has been rolled out in both rural and urban areas based on the socio-economic caste census, provides health insurance cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. Over 10.74 crore families are covered in this programme.
“An audit of PM-JAY component is proposed for 2020-2021. The audit is planned in two parts. First, it would cover a desk review with focus on data analysis to be followed by an assessment of implementation of the scheme and its results,” a senior CAG official said.
The auditors will examine whether the beneficiary registration process is robust and has not left behind the needy or if ineligible beneficiaries have been included.
“We will also ascertain whether the process of empanelment of hospitals/laboratories under the scheme is appropriate to ensure meeting prescribed criteria,” the official added.
It will also look into efficiency of the processes — reimbursement to empanelled hospitals, controls in IT system to ensure detection, flagging, assessment and prevention of frauds, etc.