Government Should Take Appropriate Action Against Those Involved in Millions of Rupees Fraud in Ayushman Bharat Chief Minister Health Insurance Scheme in Punjab: Dr. Prahlad Duggal
Chandigarh, September 13, 2024 : ( AVAJ APKI NEWS )
Dr. Prahlad Duggal from Amritsar, an ENT specialist, exposed a multi-crore scam in Punjab’s largest health insurance scheme—the Ayushman Bharat Chief Minister Health Insurance Scheme—during a press conference at the Chandigarh Press Club today. He also appealed to Chief Minister Bhagwant Singh Mann and Health Minister Balbir Singh to take immediate action on this issue.
Addressing the press conference, Dr. Prahlad Duggal revealed shocking details about the fraudulent activities conducted by Swift Hospital, Amritsar, operated by the EMC Group of Hospitals under the leadership of Pawan Arora. These activities included illegally charging patients under the cashless scheme and making false claims to insurance companies based on fake laboratory reports. Dr. Duggal stated that the EMC Group charged patients who were supposed to be treated cashlessly and defrauded the Punjab government of crores by preparing false laboratory reports and making fraudulent claims to the State Health Agency. These facts have been confirmed by the Fraud Prevention Unit of the State Health Agency, Punjab, which caught the EMC Group Hospital red-handed preparing fake laboratory reports. Pawan Arora refused to provide the hospital’s records to the SHA investigation team, which was documented in the SHA’s investigation report.
Dr. Duggal said that while Chief Minister Bhagwant Singh Mann’s government talks about putting corrupt individuals behind bars, this issue was brought to the Punjab government’s attention in 2022. No action was taken, and efforts were made to suppress the matter.
He further stated, “It is indeed surprising that Punjab’s major public health care scheme was discontinued in 2022. The reason was that the insurance company SBI-GIC ceased its services from February 25, 2022, citing significant losses due to the massive claims made by hospitals. Currently, the scheme is being operated in trust mode by the State Health Agency.”
Dr. Duggal mentioned that the real reason behind the discontinuation was the misuse of the scheme by hospitals like the EMC Group for their benefit at the expense of poor patients. Moreover, the scheme caused a loss of crores to the national and state exchequers as it was funded jointly by the central and Punjab governments in a 60:40 ratio.
During the press conference, Dr. Duggal explicitly showed entries of cash payments taken from patients under the Ayushman Bharat Chief Minister Health Insurance Scheme at Swift Hospital, Amritsar, which was run by the EMC Group owned by Pawan Arora until 2022. After Dr. Duggal exposed the cash entries and fake laboratory reports in 2022, Pawan Arora left the management of Swift Hospital.
Dr. Duggal also presented documentary evidence of fake laboratory reports prepared by Pawan Arora and his team to obtain illegal financial benefits from the government. These fraudulent laboratory reports led to claims made by the hospital being caught by the insurance company during its investigation, resulting in a show-cause notice to the hospital and later suspension of Swift Hospital, Amritsar, from the health insurance scheme. After the suspension, Pawan Arora reportedly began planning to escape from the management of Swift Hospital due to the fear of being exposed.
He further noted that Pawan Arora and his EMC Hospital, Amritsar, are also accused in the notorious fake COVID-19 report scam, which is pending before the Honorable Punjab and Haryana High Court. They are facing various charges, including attempt to murder, fraud, and tampering with government documents (FIR Number 18 dated 23.6.2020 Amritsar).
Dr. Duggal mentioned that when he confronted Pawan Arora about these irregularities, Arora initially tried to intimidate him and later offered bribes in various forms. When Dr. Duggal did not respond, Arora left the management of Swift Hospital and refused to provide documents related to the hospital’s insurance records. In response to Dr. Duggal’s request to transfer the panel, Arora replied that they could transfer the insurance list to Dr. Duggal’s firm under the clear condition that there would be no future disputes between them, which was essentially akin to offering a bribe to avoid discussing the issue.
Dr. Duggal described this as a case of mafia-like operation of hospitals where Pawan Arora and his EMC Group are misusing government funds. He demanded a high-level inquiry into the operations of the EMC Group of Hospitals and an audit of the hospital records. Such malicious elements tarnish the medical profession as these hospital operators care nothing for ethics. They should be prosecuted, and a criminal case should be filed against Pawan Arora.
He stated that it has been over two years since complaints were sent to the Chief Minister, State Health Agency, DGP, and Vigilance Punjab, but no criminal action has been taken against EMC Group and its owner Pawan Arora. The Vigilance Bureau Punjab had requested the Principal Secretary Health and Family Welfare Punjab on August 30, 2022, to send a clear recommendation for vigilance inquiry against the EMC Group, but no action has been taken so far.
Dr. Duggal concluded by saying that an investigation into the operations of the EMC Group of Hospitals will reveal the multi-crore scam as the same method is being used by this group in other government schemes as well. He appealed to Chief Minister S. Bhagwant Singh Mann and Health Minister S. Balbir Singh to order a high-level investigation into this scam and de-panel all EMC Group hospitals from government insurance schemes until the investigation is completed to protect Punjab’s healthcare system from these fraudsters.
