Jaipur: Rajasthan’s health department has taken strict action against beneficiary-level misuse and provider-led fraud by blocking Rajasthan Govt Health Scheme (RGHS) cards and suspending doctors and hospital staff. Over the past six months, the department identified more than 500 beneficiaries allegedly misusing RGHS cards and blocked them. It also recovered about Rs 2 crore from beneficiaries. Officials said intense monitoring through verification drives, beneficiary authentication, document checks, and claim-pattern analysis is on, with more blocks and recoveries likely where violations are confirmed.The department said some cardholders extended scheme benefits to ineligible relatives, enabling wrongful access to cashless treatment and other entitlements. Alongside this, officials flagged alleged manipulation by private hospitals. A health department official said investigations found instances where hospital staff took beneficiaries’ Single Sign On ID passwords to generate transaction ID, and after treatment, fraudulently adjusted tests and medicines through the hospital’s own pharmacy on the RGHS portal to obtain payments. To curb such irregularities and improve transparency, the department has launched a beneficiary-facing alert system. Registered beneficiaries will receive complete information about health services used on their RGHS card on their registered mobile number. The aim is to ensure beneficiaries can immediately detect whether any hospital, pharmacy, or other agency has raised claims without their knowledge. The department said it routinely receives complaints that false bills were submitted and payments taken under the scheme even though the beneficiary neither received the treatment nor medicines, and had no information about the claim. Under the new initiative, beneficiaries will get a monthly SMS showing total health expenditure booked on their card, with category-wise details across IPD, day care, OPD, pharmacy, and reimbursement. The message will also include the total expenditure amount, providing a consolidated statement of RGHS usage. If misuse is suspected, beneficiaries can report it to the RGHS helpline, the RGHS office, or helpline 181 for action against the concerned hospital or pharmacy.
