Doctor Accused of Fraudulent PMJAY-SEHAT Claims, Medical Record Manipulation, Unwarranted Cardiac Procedures and Exploitation of Patients; Removal from Service Possible
Nadeem Nadu
Srinagar, June 20 :
In what is being viewed as one of the most serious allegations of medical malpractice and healthcare fraud in Jammu and Kashmir in recent years, the Health and Medical Education (HME) Department has initiated major departmental proceedings against Dr. Syed Maqbool, Cardiologist at Government Medical College (GMC) Anantnag, over allegations of large-scale procedural irregularities, fraudulent insurance claims, patient exploitation and manipulation of official medical records.
Official documents accessed by KNC reveal that the HME Department has framed multiple Articles of Charge against the doctor under the Jammu and Kashmir Civil Services (Classification, Control and Appeal) Rules, 1956. The charges include falsification of records, submission of misleading claims under the PMJAY-SEHAT scheme, violation of procurement norms, unauthorized medical interventions and conduct unbecoming of a government servant.
According to the departmental memorandum, Dr. Maqbool has been directed to submit his written defence within seven days, failing which ex-parte proceedings may be initiated.
At the centre of the controversy is an alleged pacemaker implantation scam involving 103 cardiac cases booked under the “Dual Chamber Pacemaker Implantation” package on the Transaction Management System (TMS). Investigators have alleged that the procedures actually performed were Left Bundle Branch Area Pacing (LBBAP), a highly specialized cardiac intervention, while official records reflected a different procedure category to facilitate claims under the PMJAY-SEHAT health insurance programme.
The inquiry report alleges that the uploaded procedural data did not correspond with Cath Lab records, raising serious concerns about deliberate misrepresentation and fraudulent utilization of public healthcare funds.
In a startling revelation, experts reportedly found that 27 out of 55 patients who underwent the LBBAP procedure at GMC Anantnag had normal heart function and lacked established clinical indications for such intervention. The findings emerged during an expert audit conducted after the State Health Agency noticed an unusual spike in LBBAP-related claims from the institution.
The expert committee concluded that nearly 49 percent of the reviewed cases did not conform to accepted medical guidelines governing the procedure. Consequently, several claims linked to the questioned interventions were reportedly rejected.
The inquiry has further uncovered allegations of direct financial exploitation of PMJAY-SEHAT beneficiaries. In one case cited in the chargesheet, a patient identified as Peer Rafiq Ahmad was allegedly forced to pay ₹70,000 to a private vendor for a cardiac procedure despite being entitled to completely cashless treatment under the government-sponsored scheme.
Investigators claim beneficiary audits and field verification established that the payment was made outside the official hospital mechanism and that the patient attributed the transaction to directions allegedly issued by the treating doctor.
Officials have described the incident as a gross violation of PMJAY-SEHAT guidelines and a serious infringement of patient rights.
The chargesheet also accuses the cardiologist of bypassing established procurement and supply-chain mechanisms by allegedly sourcing medical implants and hardware directly from private vendors instead of utilizing approved institutional channels involving the PMJAY Section, Casualty Medical Officer and AMRIT Store.
Investigators have alleged that mandatory approvals, quality-control safeguards and procurement protocols were ignored. The inquiry further notes that certain procurement records were not made available during the anti-fraud investigation, giving rise to concerns about possible concealment of evidence.
The HME Department has termed the allegations grave in nature, stating that the acts, if proved, would constitute serious professional misconduct, abuse of official position, lack of integrity, dereliction of duty and violation of public trust.
A comprehensive list of documentary evidence, including TMS logs, Cath Lab registers, patient records, invoices, procurement documents, audit reports and findings of the State Anti-Fraud Unit (SAFU), has been included in the proceedings. Several senior medical experts, administrators and officials associated with the investigation have also been listed as witnesses.
The department has warned that the charges, if substantiated during the course of the inquiry, may attract stringent penalties, including removal from government service.
The sensational case has triggered widespread concern within medical and administrative circles and is expected to have far-reaching implications for healthcare governance, accountability and implementation of the PMJAY-SEHAT scheme in Jammu and Kashmir.(KNC)