Jaipur, July 28 (IANS) Reinforcing its commitment to transparency, accountability, and financial discipline in the Rajasthan Government Health Scheme (RGHS), the State Government has intensified action against irregularities in medicine claims.
Following an investigation by the Rajasthan State Health Assurance Agency that exposed serious instances of fraudulent billing and pricing violations, the Drug Control Department has permanently cancelled the drug licences of 31 medical stores, barring them from purchasing or selling medicines.
Alongside licence cancellations, the government has initiated recovery of excess payments, suspended defaulting stores from the Transaction Management System (TMS), and is taking further regulatory action, supported by AI-based monitoring to detect fraudulent claims, overcharging, and profiteering.
Principal Secretary (Medical & Health) Gayatri Rathore said the investigation revealed that certain medical stores had colluded with doctors and beneficiaries to submit fraudulent claims. In several cases, forged doctors’ signatures were used, while claims were raised for non-reimbursable items instead of actual medicines. Treating these as serious financial irregularities, the government initiated stringent action against the concerned establishments.
The cancelled licences include 11 medical stores in Jaipur, 9 in Bharatpur, 2 each in Nagaur and Dholpur, and one each in Hanumangarh, Bhilwara, Sikar, Jodhpur, and Alwar districts. Rathore further stated that medicine claims submitted under RGHS are subject to rigorous multi-level scrutiny.
To strengthen oversight, an Artificial Intelligence (AI)-based analytical system has been deployed to detect potential irregularities. The system automatically flags cases involving inflated pricing, abnormal Maximum Retail Prices (MRPs), incorrect pricing, unverified claims, erroneous product mapping, and other misleading information, enabling timely action under the prescribed rules.
She added that a recent investigation uncovered significant pricing irregularities in claims for medicines such as Exemptia 40 mg, Denberi Injection, Terifrac (Teriparatide), and Trulicity 1.5 mg, which were billed at rates substantially higher than prevailing market prices.
The inquiry also found that several medical stores failed to provide the mandatory minimum discount prescribed under RGHS guidelines. In cases where a minimum discount of 40 per cent was required, some stores offered discounts of only 12 per cent or less. Additionally, claims for several medicines were submitted at amounts ranging from two to five times their purchase price.
Chief Executive Officer of the Rajasthan State Health Assurance Agency, Harjilal Atal, said that in view of these irregularities, TMS access of 10 medical stores has been temporarily suspended, while 13 others have been issued show-cause notices and directed to submit their responses as per the prescribed procedure.
He further informed that the State Government is finalising a comprehensive action plan to more effectively curb profiteering and financial irregularities in medicine claims, which will be implemented shortly. Atal urged all medical stores empanelled under RGHS to strictly comply with the prescribed guidelines.
He emphasised that the government’s objective is to make the medicine distribution system under the scheme fully transparent, accountable, and financially disciplined, ensuring that eligible beneficiaries receive quality medicines at reasonable prices while safeguarding the optimal utilisation of public resources.
–IANS
arc/dan
