RGHS scam exposed in Raj: Doctor, lab operator held for multi-crore fraud

Jaipur: The Special Operation Group (SOG) wing of the Rajasthan police Monday unearthed a major fraud in the Rajasthan Govt Health Scheme (RGHS), where a doctor and a private lab operator allegedly colluded to siphon off crores of rupees from the state exchequer through fake medical claims.

The SOG has arrested two accused, including a doctor and an operator of a lab, in connection with the case. More arrests are likely in this case, officials said.

According to Additional Director General of Police (SOG) Vishal Bansal, the RGHS scheme, launched to provide free and accessible healthcare services to govt employees and the general public, was severely impacted by malpractice by certain doctors and diagnostic lab operators. He said that the arrested accused have been identified as Dr Kamal Kumar Agarwal, an orthopaedic specialist and associate professor posted at SK Hospital, Sikar, and Dr Banwari Lal, also known as B Lal, a lab operator based in Sikar.

“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,” Bansal said.

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 5-6 reports) to claim higher reimbursements. Fake prescriptions were even created on days when the concerned doctor was absent from the hospital,” he added.

SOG found a case in which an MRI report dated Dec 4, 2023, was manipulated and shown as conducted on Dec 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.
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