Rajasthan government has suspended seven doctors after an audit revealed alleged irregularities under the Rajasthan Government Health Scheme. FIRs have been ordered against a private hospital and a diagnostic centre for suspected fake billing, forged prescriptions, and misuse of beneficiary SSO credentials, raising serious concerns over accountability in public health insurance implementation.
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The Rajasthan government has suspended seven doctors following the detection of serious irregularities in the implementation of the Rajasthan Government Health Scheme (RGHS). The action came after an audit conducted by the state health authorities flagged discrepancies in billing patterns, treatment records, and empanelment status of certain healthcare facilities. The state government has also directed registration of FIRs against a private hospital and a diagnostic centre allegedly involved in fraudulent practices under the scheme.
The Rajasthan Government Health Scheme is a cashless health insurance and reimbursement system introduced by the state government to provide comprehensive medical coverage to serving government employees, pensioners, and their dependents. Under the scheme, beneficiaries can access treatment at empanelled government and private hospitals through a digital authorization process linked with SSO ID and RGHS card verification. The scheme covers outpatient care, hospitalization, investigations, and medicines as per notified package rates. Since its launch, RGHS has significantly expanded access to healthcare for government beneficiaries, but its large financial outlay and digital claim based model also require strict monitoring and auditing to prevent misuse, fraudulent billing, and unauthorized claims.
According to senior officials of the Medical and Health Department, the irregularities were identified during a detailed audit of RGHS claims in Sikar district. Principal Secretary of the Health Department stated that continuous monitoring of scheme implementation revealed suspicious transactions and procedural violations. Based on the audit findings and preliminary investigation, the department decided to initiate disciplinary action against the doctors and recommend criminal proceedings against private entities suspected of collusion and fraud.
The suspended doctors include faculty members and medical officers associated with government institutions. Among them are Dr Kamal Kumar Agrawal and Dr Sunil Kumar Dhaka from the Orthopaedics Department and Dr Mukesh Verma from the General Medicine Department of Government Medical College, Sikar. Dr Rakesh Kumar from CHC Kirwa and Dr Gajraj Singh, Dr S S Rathore, and Dr Sunil Sharma from SK Hospital are also among those placed under suspension pending departmental inquiry.
Investigators have alleged that certain private healthcare establishments misused RGHS provisions by generating fake treatment records and raising fraudulent bills. It is suspected that some beneficiaries’ SSO credentials were used to create treatment entries and process payments without genuine clinical services. The audit also indicated that some prescriptions and claims were prepared in the names of doctors who were either not on duty or not involved in patient care, raising serious questions about oversight and accountability.
The state government has ordered registration of FIRs against a private hospital and a diagnostic centre for their alleged role in generating false claims and causing financial loss to the state exchequer. Authorities have indicated that offences may include cheating, forgery, criminal conspiracy, and misuse of digital credentials. One of the private hospitals has already been de empanelled from the RGHS network, and further legal action is underway.
The suspension of government doctors has been carried out under applicable service rules pending departmental inquiry. Such suspension is considered a precautionary administrative measure and does not amount to a finding of guilt. However, if criminal liability is established during investigation, the matter may proceed to prosecution under relevant provisions of the Indian Penal Code and information technology laws. The case highlights the increasing scrutiny of public health insurance schemes and the legal risks associated with documentation and billing practices.
The Rajasthan Government Health Scheme provides cashless treatment to state government employees and pensioners. Any irregularity in its implementation not only results in financial loss but also undermines public trust in the system. The state government has indicated that stricter audits, digital monitoring, and enforcement actions will continue to ensure transparency and accountability. The present case is likely to serve as a precedent for tighter compliance and oversight in government sponsored healthcare schemes across the state.
Source: Times of India
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