West Bengal’s Swasthya Sathi scheme is facing allegations of a ₹25-30 crore fraud involving fake surgery bills, inflated treatment packages and suspected irregularities in the processing of claims, according to a report by Sangbad Pratidin. The report also said that verification exercises had identified between 25 lakh and 30 lakh suspected fake Swasthya Sathi cards in the state.
The allegations include cases in which patients were billed for surgeries that were not performed. The report said some nursing homes allegedly raised claims for procedures without touching the patient with surgical instruments, while other claims involved treatments that were not covered under the scheme’s listed packages.
Health minister Dr Shardwata Mukhopadhyay was quoted as saying that the amount identified so far was between ₹25 crore and ₹30 crore. “The opening batsman has just come out, and already corruption of ₹25-30 crore is visible. The entire innings is still left. This is not a T20 match, so it will take time,” the minister said, according to the report.
The reported irregularities concern the role of third-party administrators, or TPAs, which process claims between insurers and policyholders. The report alleged that some TPAs collected between 2% and 10% of Swasthya Sathi payments from nursing homes by threatening to hold back payments if the money was not paid.
It also alleged that some officials in the state health department approved claims unlawfully. In one pattern described in the report, a nursing home could apply for a package costing ₹2 lakh when the listed surgery was valued at ₹40,000. The report said approvals were allegedly granted by a health department official in exchange for a share of the additional amount.
Another reported practice involved patients admitted under medicine departments being shown as having undergone surgeries. The report also cited Dr Rajib Pandey of the Association of Private Hospitals and Nursing Homes, who described a case involving a family of four whose members were all listed on a Swasthya Sathi card. According to the account, surgery was performed on one member, while the other three were allegedly blocked on the scheme and allowed to stay at the nursing home’s guest house. A procedure costing ₹20,000 was allegedly billed at ₹80,000.
The report linked the discovery of suspected fake cards to door-to-door verification undertaken to establish eligibility for state health insurance and Ayushman Bharat cards. It did not provide a list of the hospitals, TPAs or officials allegedly involved, nor did it include their responses to the allegations.
The reported cases raise questions about how treatment packages are approved, how claims are audited and how beneficiary eligibility is verified under a publicly funded health insurance programme. The health minister said further information would emerge as the examination of the scheme continued.
