Irregularities in RGJAY: Maha govt to replace TPA companies

The Maharashtra government has decided to change Third Party Administrator (TPA) companies in the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) after unfair trade practices and irregularities worth Rs 500 crore were brought to light by a government-appointed task force.
State Health minister Deepak Sawant reviewed the implementation and the amount spent on the scheme and conceded that 20 per cent commission is being given to TPA companies.
"We have not appointed TPA companies. It is the responsibility of insurance companies to appoint them to handle cases and administrative works at the hospital level. We have taken serious cognisance of complaints about TPA companies and have decided to change them by the end of November," Sawant said.

According to the report submitted by the task force set up to address the persistent agrarian crisis in the state, to Chief Minister Devendra Fadnavis, malfunctioning and financial misdeeds in the scheme has resulted in a loss of Rs 500 crore to the state exchequer in the last 3.5 years.
Farm activist and president of the task force Kishore Tiwari alleged that RGJAY Society - a government body, as well as TPA companies are responsible for this corruption.
The existing term of insurance companies rendering services under the RGJAY scheme is already over, but they have been given an extension till September. The government will call for new tenders for the next three years and the procedure for it is under the pipeline.

"We have paid a premium of Rs 2,350 crore since the inception of the scheme. Every year, we pay around Rs 700 crore to Rs 750 crore as premium for the scheme. TPA has received Rs 470 crore as commission according to 20 per cent rate as mentioned in the agreement," Sawant said.

He further apprised that Rs 1,880 crore have been disbursed against claims of patients, claims worth Rs 1,632 crore have been settled but not yet disbursed while Rs 241 crore is lying idle in the accounts of RGJAY society.
Sawant said that hospitals, which have misused the scheme or cheated patients, have been banned from rendering services and removed from the empanelled list.

The state had kept a cap of 470 hospitals that can be empanelled under the scheme but the cap will now be removed.
Also the criteria of having a minimum of 50 beds will also be reduced and hospital having 30 bed facilities can participate in RGJAY scheme, Sawant said.
Outdated operations will be removed from the scheme and new procedures will be added, he said.