Rajasthan SOG arrests Sikar doctor and B. Lal Lab operator for RGHS scheme fraud worth crores

Jaipur: The Special Operations Group (SOG) of Rajasthan Police on Monday arrested an orthopaedic surgeon posted at S.K. Hospital, Sikar, and the operator of a Sikar-based diagnostic lab for allegedly defrauding the Rajasthan Government Health Scheme (RGHS) of crores of rupees through fake prescriptions and inflated test bills.

The arrested accused are Dr. Kamal Kumar Agrawal alias K.K. Agrawal, 40, an associate professor and M.S. Ortho posted at S.K. Hospital, Sikar, and Dr. Banwari Lal alias B. Lal, 65, the proprietor of B. Lal Lab in Sikar. Dr. Agrawal is a resident of Shiv Vatika, Benad Road, Murlipura in Jaipur, while Dr. Banwari Lal stays at Basant Vihar, Sikar.

Additional Director General of Police, SOG, Vishal Bansal said the action followed a complaint by the Health Department, on which case number 11/26 was registered at the SOG Police Station. The investigation was conducted by Additional Superintendent of Police Lokendra Dadarwal under the supervision of Inspector General Ajay Lamba, Deputy Inspector General Parish Deshmukh and Superintendent of Police Kundan Kanwariya.

Investigators have alleged that the accused worked together to misuse the RGHS portal in several ways — by drawing up fake out-patient prescriptions in patients’ names without actually examining them, ordering large numbers of expensive scans such as MRIs when they were not required, and billing routine MRIs as the costlier “contrast MRI” to claim higher amounts from the scheme. The SOG has also alleged that five to six separate reports were uploaded against a single actual test to inflate claims, fake prescriptions were generated even on days when the doctor was not present at the hospital, and dates on genuine reports were altered before being uploaded for payment.

In one case cited by the SOG, an MRI report dated 4 December 2023 was uploaded to the RGHS portal showing the date as 5 December 2023, even though the patient had not travelled to Sikar that day. In another instance, a claim was raised on the basis of a fake out-patient slip when the patient was actually admitted in a different hospital, and Dr. Agrawal was not present at S.K. Hospital on the date shown. Referrals issued by private doctors were also allegedly switched to the names of government doctors so that the resulting bills became eligible for payment from RGHS, the SOG said.

Bansal said the organised diversion has caused losses worth crores of rupees to the state exchequer and disrupted access for genuine RGHS beneficiaries. The role of other doctors and lab staff in the racket is being examined, he added, and strict legal action will be taken against everyone found guilty.