The Special Operation Group (SOG) of the Rajasthan police on Monday uncovered a significant fraud in the Rajasthan Govt Health Scheme (RGHS), involving a doctor and a private lab operator who allegedly colluded to siphon off crores of rupees from the state exchequer through fake medical claims.
Arrests Made in Connection with the Fraud
The SOG has arrested two accused in connection with the case: Dr Kamal Kumar Agarwal, an orthopaedic specialist and associate professor at SK Hospital in Sikar, and Dr Banwari Lal, also known as B Lal, a lab operator based in Sikar. Officials indicated that more arrests are likely as the investigation progresses.
Modus Operandi of the Fraud
According to Additional Director General of Police (SOG) Vishal Bansal, the RGHS scheme, which was launched to provide free and accessible healthcare services to government employees and the general public, was severely impacted by malpractice. He explained that doctors issued fake consultation slips without examining patients and prescribed unnecessary diagnostic tests, particularly expensive MRI scans. Based on these prescriptions, the lab operator generated fake test reports and uploaded them to the RGHS portal to claim payments.
In several cases, normal MRI scans were falsely billed as 'contrast MRIs' to inflate costs. There were instances where a single test was shown multiple times, up to five or six reports, to claim higher reimbursements. Fake prescriptions were even created on days when the concerned doctor was absent from the hospital.
Specific Instances of Manipulation
The SOG found a case where an MRI report dated December 4, 2023, was manipulated and shown as conducted on December 5 to match a forged prescription, even though the patient did not visit Sikar that day. In another instance, a patient admitted to a different hospital was falsely shown as having undergone tests under RGHS.
The case was registered by the health department at the SOG police station, and a detailed investigation was conducted under senior police supervision. The authorities are now working to identify other potential beneficiaries and collaborators involved in the scheme.
