Srinagar, June 20: The Jammu and Kashmir Government has initiated disciplinary proceedings against a cardiologist posted at Government Medical College (GMC) Anantnag following an anti-fraud investigation that allegedly uncovered irregularities in cardiac procedures conducted under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)/SEHAT scheme.
According to official documents, the Health and Medical Education (H&ME) Department has proposed action under the Jammu and Kashmir Civil Services (Classification, Control and Appeal) Rules, 1956, based on findings related to alleged medical fraud, data discrepancies and financial irregularities associated with cardiac procedures performed at the institution.
As per the charges framed by the department, the doctor allegedly booked and claimed 103 cases under the āDual Chamber Pacemaker Implantationā package on the Transaction Management System (TMS), while physical records reportedly indicated that a different procedure, Left Bundle Branch Area Pacing (LBBAP), had been performed.
The matter came under investigation after the State Anti-Fraud Unit (SAFU) received complaints regarding suspected out-of-pocket expenditure by beneficiaries covered under the PM-JAY/SEHAT scheme. Subsequent audits of online claims reportedly revealed irregular patterns in the functioning of the cardiology department.
A detailed review was later conducted by experts from SKIMS Soura, who examined a sample of 55 LBBAP cases. According to the audit findings, 27 patients, representing nearly 49 per cent of the cases reviewed, were found to have normal left ventricular function and clinical conditions that did not warrant the specialised procedure.
The expert panel reportedly concluded that these cases lacked the required clinical indications for LBBAP, leading the State Health Agency (SHA) to reject several claims on grounds of suspected medical fraud.
The investigation also raised concerns over alleged violations of the schemeās cashless treatment provisions. Officials claimed that some beneficiaries incurred out-of-pocket expenses despite being entitled to free treatment under the PM-JAY/SEHAT programme in government hospitals.
One case cited during the inquiry involved a patient who allegedly paid ā¹70,000 to a private firm for a cardiac procedure. Investigators stated that beneficiary verification and field visits confirmed the payment, which was reportedly made outside the authorised hospital system.
The probe further alleged that prescribed procurement procedures were not followed in the acquisition of medical hardware used in certain procedures. Investigators claimed that some implants and equipment could not be linked to authorised hospital inventories and that required approvals from designated authorities were not available in the records examined.
The department also alleged non-cooperation during the inquiry, stating that procurement-related information sought by investigators was not provided despite repeated requests.
According to officials, the evidence compiled during the investigation includes digital claim records, operation theatre documents, cath lab registers, procurement records, invoices and statements from beneficiaries and medical personnel.
The Health and Medical Education Department has issued a formal charge notice to the doctor and granted seven days to submit a written response. Officials said that in the absence of a reply within the stipulated period, further proceedings may be conducted ex parte.
The government has stated that the allegations involve misconduct, misuse of official position and violation of professional responsibilities. Further action will be decided after examination of the doctor’s response and completion of the inquiry process.