Health minister flags alleged irregularities in Swasthya Sathi, seeks independent probe

West Bengal Health Minister Sharadwat Mukherjee on Tuesday alleged large-scale financial irregularities in the state's Swasthya Sathi health insurance scheme, including fraudulent claims raised in the names of deceased beneficiaries, and said he would submit a detailed report to Chief Minister Suvendu Adhikari seeking an investigation by an independent agency.

The minister said his report examined suspected financial irregularities over the past decade and raised concerns about the possible involvement of insurance companies, health department officials, hospitals, doctors and beneficiaries.

He alleged that insurance claims had been submitted and cleared even years after the deaths of patients whose treatment had originally been covered under the government-sponsored health insurance scheme.

"There are cases where a patient was admitted to a hospital under the Swasthya Sathi scheme and died during treatment, but bills were raised again in the name of the same person two to three years later. Even the insurance companies cleared such claims," Mukherjee said.

"We have come across fake beneficiaries and fraudulent bills, and the situation has become a matter of serious concern," he added.

𝗙𝗿𝗮𝘂𝗱𝘂𝗹𝗲𝗻𝘁 𝗰𝗹𝗮𝗶𝗺𝘀 𝗿𝗮𝗶𝘀𝗲 𝗰𝗼𝗻𝗰𝗲𝗿𝗻𝘀

Mukherjee said the suspected irregularities were not necessarily confined to a particular section of the healthcare system and could involve multiple stakeholders responsible for processing and approving insurance claims.

"From third-party insurance companies to officials at different levels of our department, hospitals, beneficiaries and doctors, several people could be involved," he said.

The minister added that family members of beneficiaries might also have played a role in certain cases.

"There is also a possibility that officials within the department could be involved," he said, stressing the need for an impartial investigation to establish responsibility.

The allegations have raised questions about the verification mechanisms used to process claims under the Swasthya Sathi scheme, particularly in cases where beneficiaries had already died.

𝗠𝗶𝗻𝗶𝘀𝘁𝗲𝗿 𝘀𝗲𝗲𝗸𝘀 𝗼𝘂𝘁𝘀𝗶𝗱𝗲 𝗮𝗴𝗲𝗻𝗰𝘆 𝗽𝗿𝗼𝗯𝗲

Mukherjee said he would place his findings before the chief minister and seek the government's assistance in referring the matter to an independent investigating agency.

"If the chief minister extends his support, we are considering handing over the investigation into the financial irregularities in the Swasthya Sathi scheme over the past 10 years to an investigating agency," he said.

The minister maintained that an investigation conducted outside the Health Department would be necessary because officials within the department could themselves be among those involved in the alleged malpractice.

He said such an inquiry would help determine the extent of the suspected irregularities and identify those responsible.

𝗛𝗲𝗮𝗹𝘁𝗵 𝘀𝗲𝗰𝗿𝗲𝘁𝗮𝗿𝘆'𝘀 𝗿𝗼𝗹𝗲 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻𝗲𝗱

Asked about complaints against Health Secretary Narayan Swaroop Nigam, Mukherjee said he did not have the administrative authority to initiate action against the senior bureaucrat.

"If anyone has a complaint against the health secretary, they should bring it to the notice of the chief minister or the chief secretary," he said.

The minister explained that the health secretary reported to the chief secretary and that taking action against him fell outside his administrative jurisdiction.

𝗟𝗮𝗸𝗵𝘀 𝗼𝗳 𝘀𝘂𝘀𝗽𝗲𝗰𝘁𝗲𝗱 𝗳𝗮𝗸𝗲 𝗰𝗮𝗿𝗱𝘀

The latest allegations follow earlier disclosures that approximately 30 lakh Swasthya Sathi beneficiary cards had been flagged as fake, untraceable or otherwise suspicious during a verification exercise.

The scrutiny began as the state government examined beneficiary records while preparing to extend coverage under Ayushman Bharat and the Mukhyamantri Swasthya Bima Yojana.

Reports have also raised concerns about financial irregularities potentially running into thousands of crores of rupees, although the actual amount of any fraudulent expenditure has not been established.

The Swasthya Sathi scheme, introduced under the previous Trinamool Congress government, provides cashless medical coverage of up to Rs 5 lakh annually per family.

The minister's latest announcement comes as the government continues examining beneficiary records and financial transactions to determine whether fraudulent claims were systematically processed under the scheme.

Any decision to refer the matter to an independent investigating agency will depend on the chief minister's approval.