The high powered task force appointed by Maharashtra government to address the agrarian crisis prevalent in the state has brought to fore unfair trade practices and irregularities in the state sponsored mega health scheme Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY).
According to a report submitted to Chief Minister Devendra Fadnavis recently, malfunctioning and financial misdeeds in the RGJAY has resulted in a loss of Rs. 500 crore to the state exchequer in the last three-and-a-half years.
Farm activist and president of the task force Kishore Tiwari alleged that RGJAY Society- a government body as well as Third Party Administrator (TPA) companies are responsible for this corruption.
“Six months back, the government had decided to extend medical help to farmers in drought-hit regions through this scheme. However, there was no government resolution issued in this regard. Thus, as chairman of the task force I decided to probe what went wrong and came across the irregularities. This money could have been used to help farmers,” he said.
Tiwari alleged that functioning of RGJAY Health Insurance Scheme since the last three and a half years is a wilful and a deliberate violation of the provisions of Competition Act.
“The tender, contract conditions were modified later to benefit private Third Party Administrators appointed by Insurance Company contrary to the IRDA regulations,” said Tiwari.
He also claimed that disregard to free and transparent tender process caused a pecuniary loss of more than Rs. 500 crore to the state treasury.
“The role of TPA is to just check the authentication of the documents of the patient to approve his/her insurance claim. On the contrary, they were focused on rejection of cases from the hospital and they have received a 30 per cent as incentives on rejected cases,” Tiwari alleged.
“The state government has spent Rs. 2,100 crore as premium to the insurance company over RGJAY scheme during the last 4-5 years. However, the company has approved claims worth Rs. 1600 crore,” he added.
“It is thus clear that the TPA and the insurance company have siphoned off Rs. 500 crore of the state and officials from Health department are also involved in this scam,” he claimed.