Seventeen hospitals across Chhattisgarh have been flagged as “very high risk” under the Ayushman Bharat scheme, prompting state-level inspections and a review of treatment and claims records, according to the state health department. The scrutiny covers hospitals in eight districts and follows the recent de-empanelment of two facilities in Raipur.
The hospitals include seven in Raipur, three in Bilaspur, two in Durg and one each in Bastar, Kabirdham, Kondagaon, Korba and Surguja. Inspection teams visited the facilities on Wednesday and collected documents relating to treatment provided to beneficiaries under the scheme.
Officials said the “very high risk” classification is a risk flag that warrants closer examination. It does not, by itself, establish wrongdoing by a hospital. The collected records will be checked against the treatment and claims procedures prescribed under Ayushman Bharat before the state decides whether further action is required.
The inspections are focused on both the care provided to beneficiaries and the processing of claims submitted under the publicly funded health scheme. The health authorities did not disclose the specific indicators that led the National Health Authority to place the 17 hospitals in the highest-risk category.
The action comes days after two hospitals in Raipur were removed from the Ayushman scheme. The two de-empanelments took place on September 28 and 29 after recommendations from state-level investigation teams. The health department has not disclosed the specific irregularities identified in those cases.
For patients, empanelment determines whether a hospital can provide covered treatment under the scheme and submit claims for reimbursement. Any suspension, de-empanelment or other corrective action can therefore affect where beneficiaries receive treatment, although the state has not announced any change to the eligibility or treatment access of Ayushman beneficiaries as a result of the latest inspections.
State officials said monitoring of treatment and claim processing at empanelled hospitals had been intensified on the directions of Health Minister Shyam Bihari Jaiswal. The department’s next step will be to examine the records collected during the inspections and complete the investigation process.
Any action against the 17 hospitals will depend on the findings of that document verification and investigation, the health department said.