From lapses in beneficiary verification to fund underutilisation, CAG flags issues in Ayushman Bharat and PMAY in Bihar

The audit found major gaps, including weak beneficiary verification, under-utilisation and delayed release of funds, stalled hospital empanelment and claims, and discrepancies between official records and ground reality. Only 41% of targeted Ayushman beneficiaries were verified, while under PMAY-G more than half of the “completed” houses lacked toilets.

The AB-PMJAY audit — which provides health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to poor households — examined implementation, finances, registration, empanelment, claims and monitoring.

Significant closing balances of Rs 53.58 crore to Rs 159.53 crore were noted between 2018-19 and 2023-24. Spending on Information, Education and Communication (IEC) activities and IT infrastructure remained low, affecting awareness and verification, the report said.

Against a revised January 2022 target of 1.21 crore households (6.18 crore beneficiaries), only 2.56 crore beneficiaries (41%) were verified by March 2024, attributed to non-execution of a contract with the Implementation Support Agency, inadequate IEC and poor capacity building.

The report noted the IEC Cell was set up only in April 2022, more than three-and-a-half years after launch, with no state-level IEC Officer appointed. “Verification of 218.28 lakh beneficiaries was approved even though the confidence/match score was zero, one, or no score was fetched, against the required threshold of 70.”

Delays in empanelment of private hospitals ranged from one to over 200 days. Of 1,005 empanelled hospitals, 226 (22%) were inactive, while 17 had never initiated any pre-authorisation. Arogya Mitra kiosks were not functioning round-the-clock in 54 sampled hospitals; six public hospitals had none deployed, and some deployed staff were untrained.

In claims management, 8,371 of 14,015 rejected pre-authorisations (60%), amounting to Rs 12.20 crore, were turned down due to delays, wrong package selection or non-compliance. Approval delays ranged from one to 817 days. Payments could not be made in 34,193 cases due to claim rejections. The State Health Agency admitted 19,917 time-barred claims and made inadmissible payments of Rs 33.44 crore. Claim processing took up to 1,821 days for same-state cases and 1,662 days for portability cases, against stipulated timelines of 15 and 30 days.

Of 8.10 lakh claims, 1.73 lakh were processed without Aadhaar-based biometric authentication. Payments of Rs 2.31 crore were made on disabled Ayushman cards, and Rs 25.25 lakh on 139 cards not found in the system.

Monitoring was weak, with 100 posts (55% of sanctioned strength) vacant in the Bihar Swasthya Suraksha Samiti as of March 2024, along with shortfalls in key committee meetings and absence of medical audits of mortality cases.

The report recommended better use of IEC and IT funds, adherence to verification norms, timely empanelment, deployment of trained Arogya Mitras round the clock, faster claim processing, stronger IT safeguards and improved monitoring.

PMAY-G

Under PMAY-G, 30.67 lakh houses were sanctioned in Bihar between 2017-18 and 2023-24, of which 28.94 lakh (94%) were reported completed.

Expenditure ranged from 25% to 82% of available funds. Releases fell short of budgetary provisions by Rs 63.97 crore to Rs 1,734.13 crore. Central funds to the State Nodal Account were delayed by 14 to 154 days, creating an interest liability of Rs 71.08 crore, while the state share of Rs 7,182 crore was released with delays of six to 180 days.

In 1,454 test-checked cases, first instalments were delayed in 1,248 cases (86%), including delays exceeding six months to one year in 31 cases. Indira Awaas Yojana funds of Rs 6.05 crore were diverted in four districts, and Rs 7.72 crore remained blocked for over eight years. Fund Transfer Orders for 195 beneficiaries (Rs 80 lakh) were pending for two to six years, and Rs 53 lakh was transferred to incorrect bank accounts in 83 cases.

Annual Action Plans were not prepared by five of 10 sampled districts for several years, nor at the state level initially. Annual Select Lists were not prepared in 16 of 28 sampled blocks, and the mandatory 5% reservation for persons with disabilities was inadequately addressed.

Although the overall completion rate was 94%, it declined from 97% in 2017-18 to 89% in 2021-22. Data in AwaasSoft did not match departmental figures or ground reality. Physical verification of 1,454 houses found that of 1,324 marked “completed”, roof casting was pending in 306 (23%), and incorrect houses were geo-tagged in 155 cases. In 390 cases, beneficiaries who received the first instalment had not started construction even after 34 to 93 months.

Convergence with other schemes was poor. Toilets were absent in 541 of 961 completed houses (56%) verified on the ground. In 157 houses, basic amenities such as water, electricity, LPG, bathing area and waste management were missing. Data mismatches led to irregular wage payments of Rs 16.91 lakh, excess MGNREGS payments of Rs 22.33 lakh to 208 beneficiaries, and payments of Rs 22.28 lakh to ineligible beneficiaries.

Monitoring was weak, with geo-tagging errors placing houses outside the gram panchayat, district or state in 55 cases. Only 3,648 of the required 13,328 social audits (27%) were conducted in nine of 10 districts. Audit reports were delayed, and no records were maintained for complaints.

The report recommended proper beneficiary verification, timely fund release, priority for landless and disabled beneficiaries, better integration of databases, full convergence for amenities, accurate geo-tagging, and regular social audits.