Health Scheme Fraud Worth Crores Unearthed In Rajasthan, 2 Arrested

The Special Operations Group (SOG) has unearthed a major fraud in the Rajasthan Government Health Scheme, involving doctors and a lab operator allegedly causing financial losses worth crores to the state exchequer, police said.

Additional Director General of Police (SOG) Vishal Bansal said on Monday that the irregularities came to light during a probe into the implementation of the RGHS, a flagship scheme aimed at providing free and accessible healthcare services to the general public and government employees.

According to officials, the fraud was carried out through a nexus between certain doctors and laboratory operators, who allegedly generated fake prescriptions and diagnostic reports to claim reimbursements from the state government.

Two accused -- Dr Kamal Kumar Agrawal, an associate professor (Orthopaedics) posted at SK Hospital in Sikar and Dr Banwari Lal alias B Lal, operator of a private lab in Sikar -- have been arrested in connection with the case, police said.

Police said the accused doctors allegedly prescribed unnecessary diagnostic tests, including expensive MRI scans, without examining patients or even in their absence. Fake reports were then prepared and uploaded to the RGHS portal to claim payments.

In some instances, normal MRI tests were falsely billed as "contrast MRI" to inflate claims, while in others, multiple reports were generated for a single test to raise additional claims, officials said.

Investigations also revealed that prescriptions were issued on days when the concerned doctors were not present, and report dates were manipulated to process fraudulent claims.

In one case, an MRI report dated December 4, 2023, was altered to December 5 to secure reimbursement, even though the patient had not visited Sikar on that day. In another instance, claims were raised in the name of a patient admitted to a different hospital.

Officials further said that in several cases, referrals from private doctors were altered as issued by government doctors to make them eligible under the RGHS.

Based on a complaint from the health department, a case has been registered and an investigation has been launched, police said.

"The fraudulent practices have not only caused significant financial losses to the state but have also affected genuine beneficiaries and undermined the credibility of the scheme," Bansal said.

Further investigation is underway to identify the involvement of other doctors and lab staff, and strict legal action will be taken against all those found guilty, police added.

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