EX-SERVICEMEN HEALTH SCHEME BOTCH-UP: CAG RAPS DEF MINISTRY

Dear Veterans,

You would have already studied the mails from Cdr Alex, Cdr Ravi Pathak, Brig NBS, Brig N Dhand and the Minutes of our meeting held on 11 Feb 18. A passing reference was made on the CAG Report on the issue. Kindly go through the CAG Report appended below.

EX-SERVICEMEN HEALTH SCHEME BOTCH-UP: CAG RAPS DEF MINISTRY

Wednesday, 23 December 2015 | Pioneer News Service | New Delhi 12345

The Comptroller and Auditor General (CAG) has pulled up the Defence Ministry for causing a loss of more than Rs105 crore to the Exchequer due to irregularities in the Ex-Servicemen Contributory Health Scheme (ECHS).
The scheme is cashless wherein the Government pays for medical treatment of veterans and the annual budget is nearly Rs2,600 crore. There are more than 47 lakh beneficiaries of this welfare measure implemented through a network of 426 polyclinics, service hospitals and private empaneled hospitals spread all over the country.
In its report tabled in Parliament on Tuesday regarding Performance Audit of ECHS, the CAG said the audit was the first of its kind since the scheme was implemented in 2003. The Performance Audit pertained to a three-year period from 2012, it said and commented upon the “gloomy picture” of ECHS polyclinics as availability of medicines, medical equipment, manpower with the polyclinics were inadequate.
The report said the Rs105-crore loss occurred due to irregular payment of unaccounted bills involving double payments against a particular, or duplicate bills. The CAG also highlighted the “unethical” practices adopted by empaneled hospitals such as raising inflated bills. Giving an instance, the report said claims amounting to Rs42.67 lakh were raised simultaneously by two empaneled hospitals for the same patient, while he was admitted in one empanelled hospital.
In this regard, the CAG said the Defence Ministry and a company hired by it to issue smart card for ECHS were unable to account for nearly 7,000 cards. While the Ministry said it had issued 42,00,450 cards, the firm maintained it had manufactured only 41,93,019 cards.
The anomaly in these figures indicated that ECHS was holding 7,431 cards in excess, the CAG said and did not rule out misuse of these cards by those not entitled to ECHS benefits. CAG officials said in a particular case, two medical bills were raised on the same day in two different cities on the basis on one card thereby indicating possible fraud.
Elaborating upon the difficulty in tracking these payments, CAG said unlike the Central Government Health Scheme (CGHS), wherein the records of a beneficiary are stored in one central data, the ECHS works in silos and date record data are maintained separately in different cities.(Unquote)
    I request the MD ECHS to kindly respond to the observations raised by the CAG, especially the point about a Central Server, as implemented by the CGHS. Our meeting scheduled on 15 March can be meaningful,  if we have the inputs from the MD ECHS..

Col (Retd) TN Raman