CAG Reports Several Data Gap And Errors In PMJAY's Health Scheme

In its latest report, the Comptroller and Auditor General (CAG) of India alleged irregularities in the implementation of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) health scheme, which aims to provide health cover of Rs 5 lakh to over 10 crore families from the poor and vulnerable section of the population. The beneficiaries are decided based on the deprivation and occupational criteria of the Socioeconomic Caste Census (SECC) 2011. 

The report, Performance Audit of Ayushman Bharat, released on August 8, noted several other discrepancies including the absence of adequate validation controls, errors were noticed in the beneficiary database i.e. invalid names, unrealistic date of birth, duplicate PMJAY IDs, unrealistic size of family members in a household etc. 

The CAG conducted a performance audit of PMJAY from September 2018 to March 2021. The report on its findings was tabled in the Rajya Sabha Tuesday. 

"In 36 cases, two registrations were made against 18 Aadhaar numbers and in Tamil Nadu, 4761 registrations were made against seven Aadhaar numbers. Registration of multiple beneficiaries against same or invalid mobile number ranging from 11 to 7,49,820 beneficiaries were noted in the Beneficiary Identification System (BIS). In Jammu & Kashmir and Ladakh, during the period 2018 to 2021, 16865 and 335 ineligible beneficiaries respectively were identified by the SHA after cleaning the SECC data...," the report states. 

The CAG report further noted that nearly 7.5 lakh beneficiaries were linked with a single cellphone number — 9999999999. Data analysis of the BIS database revealed that there were large numbers of beneficiaries registered against the same or invalid mobile number. Besides 7,49,820 beneficiaries linked with 9999999999, 1,39,300 beneficiaries were linked to the phone number 8888888888; and 96,046 others linked to the number 9000000000. There were also at least 20 cellphone numbers to which between 10,001 and 50,000 beneficiaries were linked, as per the report.

"Mobile numbers are significant for searching records related to any beneficiary in the database, who may approach the registration desk without the ID. In case of loss of e-card, identification of the beneficiary may also become difficult. This may result in denial of Scheme benefits to eligible beneficiaries as well as denial of pre and post-admission communication causing inconvenience to them," the report states. 

The audit also observed that delayed action in weeding out the ineligible beneficiaries resulted in ineligible persons availing benefits of the Scheme and excess payment of premiums to the insurance companies. These beneficiaries are government employees. However, data collected from various states revealed that government pensioners have been included in the scheme. 

The report observed that the "National Health Authority (NHA)  while accepting the audit observation, replied (August 2022) that it is developing an SOP for adherence by the States to ensure that any SECC 2011 beneficiary family found ineligible as per AB-PMJAY criteria can be removed from the list of eligible individuals/families".

Another key finding of the reports was the unrealistic household size for registered beneficiaries under PMJAY. “Data analysis revealed that in 43,197 households, the size of the family was unrealistic, ranging from 11 to 201 members…” the report noted. “Presence of such unrealistic members in a household in the BIS database indicates not only lack of essential validation controls in the beneficiary registration process, but also the possibility that beneficiaries are taking advantage of the lack of a clear definition of family in the guidelines.”