Shimla: A major cloud has descended over Himachal Pradesh’s flagship HimCare health insurance scheme after the State Vigilance Department intensified its investigation into alleged large-scale financial irregularities, with several empanelled private hospitals now under the scanner over suspected fraudulent claims and misuse of public funds.
Investigators are examining thousands of treatment records, reimbursement claims and digital transaction trails amid allegations that hospitals generated fake admissions, exaggerated medical procedures, inflated bills and claimed payments for treatments that were either unnecessary or allegedly never provided. Officials suspect that the alleged irregularities may have caused significant losses to the state exchequer if proven.
The probe is also looking into the possibility of collusion between hospital managements and individuals involved in processing insurance claims. Vigilance teams are reportedly verifying patient records, scrutinising financial documents and matching hospital data with official claim records to identify suspicious transactions.
The alleged scam has raised serious questions over monitoring mechanisms in the HimCare scheme, which was launched to provide cashless healthcare of up to ₹5 lakh annually to eligible families in empanelled hospitals. Any misuse of the programme could directly affect beneficiaries who depend on it for life-saving treatment.
Officials have indicated that the investigation is likely to widen further if additional evidence emerges. Those found guilty could face stringent legal action under relevant anti-corruption and criminal laws, while hospitals found violating scheme guidelines may also risk empanelment cancellation.
