Many loopholes found in CM health insurance scheme

While the empanelled hospitals lack NABH accreditation, many eligible candidates are not enrolled in the scheme. The audit stated that all families having a ration card and an annual income of less than Rs 72,000 are enrolled as beneficiaries. Though orphans, families having differently-abled persons, migrant workers and Sri Lankan refugees are eligible for enrolment without income limit, the audit report revealed that out of 55,384 orphans in 1,235 government and private orphanages in the state, only 664 out of 2,687 children from government run orphanages were enrolled, which was on one per cent of the total orphaned children in the state. Against 32,555 Sri Lankan refugee families, only 15 per cent, that brings to about 4,815 families, were enrolled. Meanwhile, none of the 21,538 identified migrant workers were enrolled. The audit found that no system was put in place to enroll all the beneficiaries from these sections of the society, but the state had replied in January 2020 that enrolment of orphans, Sri Lankan refugees and migrant workers was under progress with the assistance of District Administrative departments concerned. The report also found that many ineligible families were enrolled in the scheme as only 96.46 lakh families had Public Household cards, however, the scheme had more than 147 crore beneficiaries. The audit compared the beneficiary data with the data of state pensioners and found that 1.08 lakh pensioners, whose annual income exceeded Rs 72,000, were enrolled under CMCHIS.

Duplicate cards

The analysis of the electronic database of beneficiary details furnished by Tamil Nadu Health Systems Project (TNHSP) disclosed that during 2009 to 2015, 0.83 lakh duplicate CMCHIS cards were issued to families with one ration card. As only one card was allowed per family and insurance premium is paid based on number of cards, issue of more than one card per family resulted in avoidable insurance premium of Rs 15.64 crore during 2016-19 on these ineligible cards. However, the government had replied in January 2020 that in order to improve access to health care, more than one insurance cards were issued with a single ration card number as newly formed families did not possess ration cards. The lapses in the empaneled hospitals were also found under CMCHIS. As on March 2019, a total of 1,008 hospitals were empanelled under CMCHIS, including 265 government hospitals and 743 private hospitals. A total of 251 empanelled hospitals did not have NABH accreditation even after a lapse of one year, while 64 hospitals had lost the accreditation and 154 hospitals were accredited belatedly after the expiry of grace period. Meanwhile, the Insurance Company was also responsible for the lapses, no action was taken against the company. The data analysis of 2016-19 shows that the discrepancies between date of admission and date of discharge were noticed in 613 cases.

Improper planning

The report also revealed improper planning of three multi-storey buildings at Rajiv Gandhi Government General Hospital, which led to them being idle for a long period of time. The Rheumatology block, hepatology block, Nephrology Block and an out-patient block was constructed at the hospital at the cost of Rs 124.48 crores by June 2018, but the buildings were not commissioned until March 2020. Moreover, the excessive procurement of drugs by RAMO, Madurai and Director of Medical and Rural Health Services resulted in locking up of Rs 16.39 crores, the report said.