CAG audit reveals inflated enrolment in West Bengal's Swasthya Sathi health scheme

The Comptroller and Auditor General (CAG) has identified significant irregularities in West Bengal's Swasthya Sathi health insurance scheme, which was a flagship programme of the previous Trinamool Congress government. In a report tabled in the state assembly, the CAG found that the number of families enrolled under the scheme was 10% higher than those holding ration cards under the Public Distribution System (PDS). This discrepancy raises concerns about ineligible beneficiaries receiving benefits.

The Swasthya Sathi scheme, launched in February 2017, provides health insurance coverage of up to Rs 5 lakh per family per year, with the entire premium paid by the state government. Former Chief Minister Mamata Banerjee had projected it as a superior alternative to the Centre's Ayushman Bharat scheme. However, the CAG report notes that as of March 2023, 2.43 crore families were enrolled under Swasthya Sathi, compared to 2.21 crore ration card holders as of August 2023.

The report also highlights several other irregularities. Only one Swasthya Sathi card was supposed to be issued per family, in the name of the eldest female member, but the CAG found no documentation confirming compliance with this rule. Test checks in six districts—Birbhum, Hooghly, Purba Medinipur, Jalpaiguri, North 24 Parganas, and Murshidabad—revealed that in all but Jalpaiguri, the number of families enrolled for the health scheme exceeded those receiving ration. Murshidabad had the largest gap, with 21.07 lakh Swasthya Sathi families against 16.85 lakh ration card holders as of January 2024.

The nodal agency for the scheme admitted the gap, attributing it to population growth and family splitting. It stated that data sanitization and Aadhaar linking were underway to remove duplicates. However, the CAG concluded that the government's response showed no clear reason for the discrepancy, and that there was an inherent risk that non-residents or those covered under other schemes might possess multiple Swasthya Sathi cards.

Further, the CAG flagged improper grading of empanelled hospitals. None of the 27 government super-speciality hospitals were graded as Grade-A, leading to lower package rates and reduced revenue for these institutions. Conversely, 31 hospitals were granted higher grades than their infrastructure and services warranted, resulting in overpayments. The report also cited non-recovery of penalties from partners for delayed claim settlements and excess payments.

The CAG reports in West Bengal are being published for the first time in four years, following the change of government from the Trinamool Congress to the Bharatiya Janata Party. A total of 28 reports were tabled in the assembly.