Real Docs, Fake Operations, Real Money

A Rs. 14 lakh scam, in the name of the Health Insurance Scheme, has come up from Rajmahal Nursing Home in Basantpur area of Siwan district in Bihar. The scam came to light after District Magistrate (DM), Lokesh Kumar Singh, formed an inquiry committee under his chairmanship including Civil Surgeon Dr. Chandrasekhar Kumar and eye-specialist Dr. L.B. Chaudhary as members and probed the matter. Lokesh Kumar Singh found that the administrator along with a couple of doctors of Rajmahal Nursing Home have conducted eye-operations on 183 patients but only on paper, and have claimed Rs. 14 lakhs from an insurance company.

The report of the inquiry has made it clear that eye operations were not actually performed, but were carried out only in official records to claim insurance. The representatives, from ICICI Lombard who used to be doctors, inspected the nursing home many times but none of them reported anything.

The insurance company has paid 50 per cent of the amount claimed. The report of the inquiry has made it clear that the operations were not actually performed, but were carried out only in official records to claim the insurance amount. Dr. Chaudhary said that the operations shown in the records are possible only in a few hospitals in India while Dr. Chandrasekhar said that they have met some of the patients, who were said

to have been operated upon, but those patients averred they had come to the hospital on account of stomach problems; they never had any eye problem.

In the wake of the findings of the inquiry, Lokesh Kumar filed an FIR (First Information Report) against the administrator of the nursing home, Aizaz Ali, and two other doctors who indulged in fraudulent practices. He also instructed the police to recover the money which the doctors have claimed from the insurance company. After filing of the FIR, the police started investigation, but even after weeks they have not been able to arrest the people responsible for this fraud. A few days later the DM was transferred and the case was closed. Though a doctor was arrested before the transfer of the DM, he got bail from the court. No other arrests have been made in this case. The monitoring of treatment under the Health Insurance Scheme was done under the supervision of representatives from ICICI Lombard, who used to be doctors. While this fraud was going on, the representatives from ICICI Lombard inspected the nursing home many times but none of them reported anything. So the role of some of the employees from ICICI Lombard is also dubious in this case. Due to the inefficiency of the police, the insurance money has not been recovered and the people involved in this forgery have also not been arrested.

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It was told that the representatives from ICICI Lombard who used to come for inspection never really checked on the erring doctors while the doctors who were working properly were ‘inspected’ many times unnecessarily. Fresh wounds of operated patients were checked repeatedly by opening their bandages, but the doctors involved in the fraud were not checked even once.

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