Kolkata, 23 August (H. S.): Amid efforts to make healthcare more accessible through schemes such as Ayushman Bharat, the Chief Minister's Health Insurance Scheme and Swasthya Sathi, allegations of financial irregularities involving a section of private nursing homes and hospital operators have surfaced in West Bengal.

A Health Department inspection at a private multi-speciality nursing home in East Burdwan reportedly detected alleged irregularities, including the preparation of fraudulent bills to claim funds allocated under the Swasthya Sathi scheme. The Health Department has sought an explanation from the hospital authorities.

According to Health Department sources, irregularities were detected on several counts. Under Swasthya Sathi, the Medical Management Package does not have a fixed expenditure ceiling for certain hospitalised patients, while separate packages for surgical procedures have specified limits.

The nursing home has allegedly shown patients requiring surgery as cases under the Medical Management Package and generated bills accordingly. A Health Department official claimed that while orthopaedic surgeries generally cost around ₹30,000 to ₹45,000, treatment for brain stroke was allegedly shown under the Medical Management Package at ₹90,000. Officials reportedly found 14 such cases.

The inspection team also allegedly found cases where patients suffering from conditions not covered under the Swasthya Sathi scheme were admitted and shown as suffering from illnesses covered by the scheme.

Another alleged irregularity concerned the qualifications of doctors performing procedures. A Health Department official said hospital records showed that spinal surgeries, normally performed by neurosurgeons, had allegedly been carried out by an orthopaedic surgeon.

Officials also suspect that old medical records were allegedly being manipulated. According to a Health Department official, CT scan reports of previous brain-stroke patients were allegedly kept and subsequently used to portray orthopaedic patients as stroke patients. The patient's name and scan date were allegedly edited digitally on the reports.

Members of the private nursing home sector have claimed that the East Burdwan incident may be only the tip of the iceberg, alleging that similar practices may exist in several districts. These allegations, however, have not been independently verified.

The Association of Private Hospitals and Nursing Homes has acknowledged concerns over such alleged practices. Secretary Rajib Pandey said the association does not support such corruption and wants government healthcare schemes to reach beneficiaries transparently. He said the organisation has decided not to admit nursing homes and hospitals allegedly involved in such malpractice as members.

Meanwhile, Pankaj Mukhopadhyay, one of the key persons associated with the nursing home facing the allegations, said the management received a letter from the Health Department last Thursday. He stated that the group operates four hospitals and that it may not be possible for the owners to know every detail of operations. He added that an internal audit was underway and that the management would respond after receiving the report on Monday. The Health Department has also reportedly been informed about the internal audit.

The allegations are currently under examination, and further action will depend on the findings of the Health Department's investigation and the hospital's response.

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Hindusthan Samachar / Priyanka Pandey