CAG finds ₹33.44 crore paid on time-barred AB-PMJAY claims

This audit examined the implementation and financial management of two central government schemes in Bihar: Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) for the period September 2018 to March 2024, and Pradhan Mantri Awaas Yojana-Gramin (PMAY-G) for the period 2017-24.

Who it concerns: Government of Bihar, specifically the Departments of Health and Rural Development, and the Bihar Swasthya Suraksha Samiti (BSSS).

What the auditor found

• AB-PMJAY: Significant closing balances of ₹53.58 crore to ₹159.53 crore remained unspent in FYs 2018-19 to 2023-24.
• AB-PMJAY: Only 41% (2.56 crore) of the targeted 6.18 crore beneficiaries were verified as of March 2024.
• AB-PMJAY: 218.28 lakh beneficiaries were verified with zero or low confidence/match scores, implying insufficient identity documents.
• AB-PMJAY: 226 hospitals (22% of empanelled) were inactive; 17 had not initiated any pre-authorisations since empanelment.
• AB-PMJAY: 8,371 pre-authorisations (₹12.20 crore) were rejected due to delays or errors, denying treatment to beneficiaries.
• AB-PMJAY: SHA made inadmissible payments of ₹33.44 crore on 19,917 time-barred claims.
• AB-PMJAY: Claim payments of ₹2.31 crore were made on 2,186 disabled Ayushman cards.
• AB-PMJAY: Payments of ₹25.25 lakh were made on 139 Ayushman cards that did not exist in the beneficiary database.
• AB-PMJAY: 1.73 lakh claims were processed without mandatory Aadhaar-based biometric authentication.
• AB-PMJAY: 100 posts (55% of sanctioned strength) were vacant in BSSS as of March 2024.
• PMAY-G: 30.67 lakh houses were sanctioned, but only 28.94 lakh were completed during FYs 2017-18 to 2023-24.
• PMAY-G: Full assistance was paid despite non-commencement of construction in some cases.
• PMAY-G: Short person days were provided in convergence with MGNREGS.
• PMAY-G: Discrepancies were found in the geo-tagging of photographs and maintenance of scheme records.

Also in the document

• CAG found that ₹33.44 crore was paid as inadmissible claims on time-barred cases under AB-PMJAY.
• CAG reported that only 41% of the targeted beneficiaries for AB-PMJAY in Bihar had been verified as of March 2024.
• CAG noted that 226 hospitals empanelled under AB-PMJAY were inactive, with 17 never initiating any pre-authorisations.
• CAG identified that 1.73 lakh claims under AB-PMJAY were processed without mandatory biometric authentication.