Rashtriya Swasthya Bima Yojana

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    Detailed Compliance Audit of Rashtriya Swasthya Bima Yojana (2012-2017)
    (CAG of India, 11-07-2019) CAG of India
    Detailed compliance audit of “Implementation of RSBY in West Bengal” was conducted during January to June 2017 covering the period 2012-17. The records of State Nodal Agency, RSBY and District Nodal Officers (DNOs) of six districts were test-checked. Audit team also visited some Government hospitals and Private Nursing Homes empanelled for RSBY in the test-checked districts. The major audit findings are following: 1. The State had not started covering new categories of beneficiaries (street vendors, beedi workers, domestic workers, building and other construction workers and MGNREGA workers) targeted to be brought under the scheme. 2. The insurance companies fell short of the target of empanelling at least two hospitals in a block/ municipality. As many as 76 blocks/ municipalities in five test-checked districts were found to have either only one hospital or no hospital empanelled at all. 3. Expeditious settlement of claims was crucial for successful implementation of health insurance scheme. However, the pace of settlement of claims by the insurance companies was unsatisfactory. In three of the test-checked districts, 3792 claims worth INR 1.90 crore for the period 2014-17 were pending. A number of private hospitals in two test-checked districts had discontinued services under the RSBY attributing the same to unsatisfactory services of the Insurance Companies. 4. The RSBY patients had often to purchase medicines from shops in the open market. Thus, the basic aim of cashless treatment was not achieved.