Gujarat Government Penalizes 24 Ahmedabad Hospitals for Overcharging PM-JAY Cardholders: A Deep Dive
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Introduction
The Gujarat government has levied penalties against 24 empanelled hospitals in Ahmedabad for unlawfully charging patients holding PM-JAY cards. This action underscores the state's commitment to ensuring free and cashless treatment for economically vulnerable families under the Ayushman Bharat scheme. This development has brought the functioning of hospitals participating in the Pradhan Mantri Jan Arogya Yojana (PM-JAY) under renewed scrutiny, highlighting persistent challenges in the delivery of cashless healthcare services.
The Disclosure in the Assembly
The issue came to light during the ongoing Budget session of the Gujarat Assembly on Thursday, March 12, 2026, when the state government responded to a question raised by a Congress legislator concerning violations of the PM-JAY scheme. In its written reply, the government acknowledged that as of January 31, 2026, multiple incidents had been recorded in Ahmedabad city and district where patients were allegedly charged for treatment despite being eligible for free care under the scheme. This admission has put a spotlight on the implementation of the program, which is designed to provide cashless treatment to economically weaker sections of society.
Understanding the PM-JAY Scheme
The Pradhan Mantri Jan Arogya Yojana (PM-JAY), often referred to as Ayushman Bharat, is a flagship health insurance scheme by the Government of India, aiming to provide health coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization. The scheme is designed to offer cashless and paperless access to services for beneficiaries at empanelled public and private hospitals. In Gujarat, the scheme is implemented in conjunction with the state's Mukhyamantri Amrutam (MA) Yojana, providing comprehensive health protection to eligible families. Currently, 2.73 crore Ayushman cards are active in Gujarat under PM-JAY and Mukhyamantri Amrutam Yojana, with over 57 lakh new cards issued in the last two years.
Nature of Violations and Penalties
According to data tabled in the Assembly, 24 hospitals in Ahmedabad recognized under the PM-JAY scheme were found to have violated its guidelines over the past two years by charging patients. Following complaints and verification, authorities issued formal notices and imposed financial penalties on these institutions for breaching the scheme's rules. A cumulative fine of Rs 36,84,369 has been levied on these 24 Ahmedabad hospitals during the past two years for recovering fees from Ayushman cardholders. Some reports indicate the total fines amounted to ₹39.84 lakh. This action by the state health department comes amidst growing concerns about hospitals participating in welfare schemes continuing to charge patients despite clear guidelines mandating cashless treatment.
Types of Irregularities Reported
- Overcharging: Demanding additional payments from PM-JAY cardholders for services that are supposed to be cashless.
- Inflating Bills: Artificially increasing the cost of treatment or procedures.
- Unnecessary Procedures: Conducting treatments or surgeries without medical necessity to claim government reimbursements. The Khyati Hospital case in Ahmedabad in November 2024 is a prominent example, where patients allegedly underwent unwarranted angioplasties, leading to two deaths.
- Manipulating Records: Falsifying pathological or X-ray reports to facilitate admissions or claim higher packages.
- Inadequate Infrastructure/Manpower: Not meeting the prescribed infrastructure or staffing criteria required for empanelment.
Broader Crackdown on Irregularities
The penalization of these 24 Ahmedabad hospitals is part of a larger, ongoing crackdown by the Gujarat government on irregularities within the PM-JAY scheme. In the past two years, the state government has disempanelled a total of 49 hospitals across Gujarat for various violations. While the suspension of 20 of these hospitals was later revoked after they complied with prescribed norms, 29 other medical institutions remain suspended from the scheme. Health Minister Praful Pansheriya has reiterated the government's commitment to taking strict action against hospitals found violating PM-JAY rules and standard operating procedures (SOPs).
Notable instances of action taken include JCCC Hospital in Jamnagar, which was fined Rs 8.69 lakh for misusing government funds, and a doctor associated with it, Dr. Parth Vora, who was suspended from performing operations under PM-JAY. Additionally, a major scandal involving Khyati Hospital in Ahmedabad in November 2024, where two patients died after alleged unnecessary angioplasties, significantly intensified the state's scrutiny. Over the last two years, a statewide crackdown has led to the suspension of 34 private hospitals and 17 doctors.
Government Stance and Future Outlook
The Gujarat government maintains a zero-tolerance approach to fraud and irregularities in the Ayushman Bharat scheme. Officials, including Health Commissioner Harshadkumar Patel, have affirmed that the state consistently penalizes misuse and has sharpened oversight since prominent cases of fraud came to light. The government is committed to transparency and accountability, ensuring that any hospital engaging in unnecessary procedures or breaching guidelines faces strict action. The issue of alleged misuse of the scheme has been raised by opposition leaders, like Congress MLA Amit Chavda, who emphasized that PM-JAY should remain a blessing for beneficiaries and not a tool for profit for private hospitals.
How Patients Can Seek Redressal
The PM-JAY scheme includes a robust, three-tier grievance redressal system at the district, state, and national levels to address issues faced by beneficiaries. Patients can file complaints through various mediums, including the web-based Centralized Grievance Redressal Management System (CGRMS), central and state call centers, emails, or letters to state health agencies. This mechanism is crucial for holding errant hospitals accountable and ensuring that beneficiaries receive the free and cashless treatment they are entitled to under the scheme. As of November 25, 2024, over 18,000 grievances had been registered nationally on the CGRMS system concerning issues like denial of treatment, charges for services, and unavailability of Pradhan Mantri Arogya Mitra.