Maharashtra warns of FIRs against hospitals charging patients under cashless health schemes

Maharashtra Health Minister Prakash Abitkar on Monday warned of strict action, including the filing of FIRs , against hospitals found charging patients covered under government-run cashless health schemes, asserting that beneficiaries should not have to pay “a single rupee” for treatment.

Speaking during the ongoing budget session of the Maharashtra Assembly, the minister said the state government had examined around 368 complaints alleging that hospitals demanded additional payments from patients despite treatments being covered under the Mahatma Jyotiba Phule Jan Arogya Yojana and the Centre’s Pradhan Mantri Jan Arogya Yojana . The government has recovered penalties totalling Rs 60 lakh from hospitals found violating the rules.

Abitkar said 12 hospitals have already been delisted from the schemes after investigations confirmed irregularities. He warned that hospitals repeatedly violating the rules could face criminal action, including FIRs , besides financial penalties and removal from the schemes.

The minister also highlighted that the integration of the state scheme with the Centre’s Ayushman Bharat programme has significantly expanded the scope of treatment. The number of ailments covered has increased from 1,356 to around 2,300–2,399 , and treatment package rates have also been revised upward to make participation viable for hospitals.

Under the schemes, eligible beneficiaries can avail cashless treatment of up to Rs 5 lakh per year , aimed at ensuring access to quality healthcare for economically weaker sections.The plans cover secondary and tertiary care for critical illnesses like heart diseases.

To strengthen oversight and prevent misuse, the Maharashtra government has introduced artificial intelligence-based monitoring systems to analyse complaints and detect suspicious patterns in claims submitted by empanelled hospitals. Authorities believe this technology will help improve transparency and curb fraud in the implementation of the schemes.

The minister further informed the House that district-level monitoring committees have been constituted to review the functioning of the schemes every three months. These panels are headed by guardian ministers and include MLAs and government officials to ensure better supervision at the local level.

Abitkar urged legislators to actively monitor hospitals in their constituencies and report any violations to the government. “If even a single complaint is brought to our notice, action will be taken immediately,” he said.

Reiterating the government’s commitment, the minister said the schemes were designed to provide free and accessible healthcare to poor and vulnerable citizens , adding that any attempt by hospitals to exploit beneficiaries would not be tolerated.