The Medical and Health Department will take effective steps to enhance transparency, financial robustness, and institutional restructuring of the Rajasthan Government Health Scheme (RGHS). To achieve this, the plan will be technically strengthened and human resources increased. An Anti-Fraud Unit will also be established.
Health Minister Shri Gajendra Singh Khimsar reviewed the RGHS scheme at the Health Building and directed that all related operations be carried out with full transparency and timeliness. Pending and suspicious cases will be reviewed promptly for resolution.
He emphasized the preparation of a new SOP and guidelines soon to ensure beneficiaries do not face difficulties in treatment and stakeholders like hospitals and pharmacies are not unnecessarily troubled.
The minister ordered assessment and recruitment proposals for doctors, pharmacists, administrative, and technical staff to ensure no shortage of human resources.
An Anti-Fraud Unit comprising IT, claim audit, medical audit, and monitoring experts will be formed. A grievance redressal cell and centralized complaint resolution center will be established with an online tracking system and district-level complaint cells.
Payments to hospitals and pharmacies will be made timely, ensuring smooth financial management without obstructing treatment.
Rajasthan State Health Assurance Agency CEO Mr. Harjeelal Atal reported that over ₹350 crore has been paid to hospitals for pending dues, with ₹300-400 crore planned for the upcoming month. The Medical and Health Department has been appointed as the budget controlling office for RGHS, ensuring quicker budget management and accountability.
Project Officer Ms. Shipra Vikram revealed detection of fraudulent practices involving fake prescriptions and bills through collusion between some doctors and pharmacies. Such hospitals showing unnecessary 24-hour admissions have been identified. Strict monitoring and suspension or cancellation of memberships are being enforced. Technical steps like e-prescription, e-billing, real-time monitoring, regular audits, and surprise inspections are underway. Defaulters will be removed from the scheme and face legal action.
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