Health authorities have detected 342,988 fraud cases of hospitalisation, including 56,217 involving surgeries, under the Pradhan Mantri Jan Aarogya Yojana (PMJAY) scheme, the government-funded cashless treatment programme, the Union health ministry informed Parliament on Friday.

The Union minister of state for health, Prataprao Jadhav, in a written reply to Congress MP Murari Lal Meena, said the fraud cases as on December 11, 2024, include 286,771 cases of medical management and 56,217 cases of surgical management.

The fraud cases make up only 0.5 per cent of over 68 million hospital admissions since the Centre launched the PMJAY in 2019. The scheme covers up to ₹500,000 per year in hospitalisation costs for poor and vulnerable households.

Studies in recent years relying on independent datasets have flagged concerns about unnecessary Caesarean sections and hysterectomies in India that appeared to target disadvantaged women and signal what sections of public health experts suspect is poor regulation and financial exploitation.

The prevalence of Caesarean sections in India increased from 17.2 per cent in 2016 to 21.5 per cent in 2021, according to data from the National Family Health Survey 2019-21. Prevalence in private hospitals was 49 per cent in 2021, more than double the national average.

The PMJAY scheme — expanded this year to all aged 70 years and above irrespective of their household income — works under an insurance model with empanelled government and private hospitals receiving reimbursement from funds that come from the Centre and states in a 60:40 ratio.

Meena, the Lok Sabha member from Dausa in Rajasthan, had asked whether the government was aware of the deaths after unnecessary angioplasty surgeries of patients and sought information about fraud cases or unnecessary surgeries in hospitals empanelled under the PMJAY.

The health ministry said suitable penal actions had been initiated in instances involving death due to unnecessary angioplasty and surgeries.

The Gujarat health department had last Monday said that it had debarred five private hospitals from providing services under the PMJAY after a probe found that two healthy people had died after receiving angioplasty, a procedure to open blocked coronary arteries.

Two doctors working in these hospitals have also been suspended from providing services under the PMJAY, a PTI report from Ahmedabad said on Monday.

The report said the Gujarat health department’s action comes against the backdrop of a hospital in Ahmedabad found performing “unnecessary angioplasty” on several PMJAY cardholders to siphon off government money.

Sections of health experts within and outside India have earlier expressed concerns about unnecessary coronary stents. The Lown Institute, a US think tank, had in an October 2023 report estimated that US hospitals had performed over 229,000 unnecessary coronary stents from 2019 to 2021.

“Of the approximately one million stents placed by hospitals, 22 per cent met criteria for overuse,” the institute said in its report. Cardiologist Vikas Saini, president of the Lown Institute had said in a media release that the overuse of stents is “incredibly wasteful and puts hundreds of thousands of patients in harm’s way”.

Jadhav, in his reply to Meena’s question, said the PMJAY scheme is “governed on a zero-tolerance approach to any kind of fraud”. He said the National Health Authority has established multiple mechanisms to prevent, detect and deter different kinds of fraud that could take place in the scheme.