CAG flags ‘gaps’ in Ayushman Bharat implementation in Bihar

Patna: The Comptroller and Auditor General (CAG) has flagged gaps in the implementation of Ayushman Bharat in Bihar, citing weak awareness measures and procedural hurdles that restricted the scheme’s reach and resulted in eligible patients being denied treatment benefits.

The audit observed that expenditure on information, education and communication (IEC) activities was far below requirements, weakening beneficiary awareness and contributing to low verification of targeted beneficiaries. Bihar’s revised target, set in January 2022, envisaged coverage of 6.18 crore beneficiaries, but only 2.56 crore — around 41% — had been verified as of March 2024.


The CAG also highlighted issues in the pre-authorisation process affecting both beneficiaries and hospitals. Of 14,015 pre-authorisations rejected, 8,371 cases — about 60% — amounting to Rs 12.20 crore were rejected by Pre-authorisation Panel Doctors (PPD). The report attributed these rejections to delays in initiating pre-authorisation, incorrect selection of treatment packages and non-compliance with queries raised by the Pradhan Mantri Aarogya Mitra (PMAM) or Medical Coordinator (MEDCO), resulting in denial of treatment under the scheme.

It further noted that PMAM kiosks, intended to assist beneficiaries in completing formalities, were not operating round-the-clock in 54 sampled public and private hospitals.

On hospital onboarding, the CAG said empanelment of 383 private hospitals was approved with delays, including 159 hospitals empanelled after delays of 200 days or more.

As of September 2024, Bihar had 1,005 hospitals empanelled under the scheme. However, 226 hospitals (22%) were shown as inactive for not initiating pre-authorisations for beneficiaries during the previous three months.

The audit also flagged deficiencies in claim processing. Payments could not be made in 34,193 cases due to rejection of claims by Claim Panel Doctors (CPD) over delayed initiation, wrong package selection, non-uploading of mandatory documents and non-submission of replies to queries by hospitals.

In another compliance lapse, the CAG found that out of 8.10 lakh claims, 1.73 lakh claims worth Rs 199 crore were processed without mandatory Aadhaar-based biometric authentication at the time of admission and discharge.