PMJAY-SEHAT fraud allegations rock GMC Anantnag

Srinagar, Jun 20: A major controversy has surfaced at Government Medical College (GMC) Anantnag after serious allegations of medical malpractice, procedural irregularities and misuse of public healthcare funds emerged in connection with cardiac procedures conducted under the PMJAY-SEHAT health insurance scheme.
According to reports, the Jammu and Kashmir Health and Medical Education (H&ME) Department has initiated a formal departmental inquiry against a senior cardiologist and placed him under suspension pending completion of the investigation.
The case revolves around Dr. Syed Maqbool Ahmad Shah, Associate Professor of Cardiology at GMC Anantnag, who is facing allegations of procedural misrepresentation, generation of questionable reimbursement claims under the PMJAY-SEHAT scheme, bypassing approved procurement channels and performing specialized cardiac interventions on patients who allegedly did not meet the required clinical criteria.
As per official documents, the allegations came to light during an investigation carried out by the State Anti-Fraud Unit (SAFU), which reviewed claims submitted under the government-funded PMJAY-SEHAT programme. During the audit, investigators reportedly discovered significant discrepancies between records uploaded on the online Transaction Management System (TMS) and entries maintained in the Cath Lab Procedure Register at GMC Anantnag.
The inquiry report alleges that reimbursement claims were generated for 103 cases under the package category of Dual Chamber Pacemaker Implantation, whereas the actual procedures performed were reportedly Left Bundle Branch Area Pacing (LBBAP)—a highly specialized cardiac pacing technique generally reserved for patients suffering from specific conduction abnormalities and impaired heart function. Investigators suspect that the procedures may have been categorised differently to facilitate claims under the insurance scheme.
The unusually high number of LBBAP procedures performed at the institution prompted a detailed review by experts from the Department of Cardiology at SKIMS Soura. An expert panel examined 55 selected cases and found that 27 patients, nearly 49 percent of those reviewed, had normal left ventricular function and did not appear to meet established medical indications for the procedure.
The findings have triggered serious concerns regarding adherence to accepted treatment protocols and whether all interventions carried out were medically justified.
Healthcare experts note that LBBAP is generally considered an advanced pacing technique intended for carefully selected patients. The audit findings have therefore intensified scrutiny over patient selection criteria and procedural decision-making at the institution.
The investigation has further highlighted allegations that some beneficiaries entitled to completely cashless treatment under PMJAY-SEHAT were allegedly asked to bear substantial expenses.
In one instance cited by investigators, a patient was reportedly directed to pay nearly Rs 70,000 to a private vendor for medical hardware used during treatment despite being covered under the government insurance scheme.
Authorities have also alleged that certain cardiac implants and medical devices were procured through private vendors rather than through approved institutional procurement mechanisms. Such practices, officials argue, undermine transparency, accountability and quality-control safeguards established within public healthcare institutions.
The departmental memorandum accuses the cardiologist of manipulating procedural records, violating government guidelines, misusing his official position and compromising professional integrity and patient welfare. Officials maintain that if these allegations are substantiated, they would amount to grave misconduct and a serious breach of public trust.
Acting on the findings, the Health and Medical Education Department has initiated major disciplinary proceedings under the Jammu and Kashmir Civil Services (Classification, Control and Appeal) Rules, 1956.
Dr. Maqbool has been served a formal chargesheet and directed to submit a written response within seven days. He has also been given an opportunity to present his defence before the designated inquiry authority.
Meanwhile, the government issued Government Order No. 504-JK (HME) of 2026 dated June 20, 2026, placing Dr. Syed Maqbool Ahmad Shah under suspension with immediate effect pending completion of the inquiry. During the suspension period, he has been attached to the office of Government Medical College Jammu.
Health and Medical Education Minister Sakina Itoo confirmed that the inquiry process had already been set in motion and urged people not to prejudge the outcome before the investigation is completed.
“We have already started the inquiry and suspended the doctor concerned. Let the inquiry be completed,” the minister said while responding to media queries.
She reiterated the government’s commitment to transparency and accountability in the healthcare sector and assured that strict action would be taken against anyone found guilty.
“The inquiry was initiated earlier by the department. We are waiting for the report, and whoever is found responsible will face action as per the law,” she stated.
Responding to the allegations, Dr. Syed Maqbool strongly denied any wrongdoing and described the accusations as “fabricated.”
He argued that portions of the departmental memorandum were being selectively circulated and interpreted as established facts, despite the inquiry still being underway.
“What is being circulated in the media is totally different from the actual report. People are treating a memorandum of allegations as a final verdict, which is not correct,” he said.
The cardiologist maintained that GMC Anantnag had already submitted detailed replies supported by documentary evidence addressing every allegation raised by investigators.
“We have replied to every allegation with documentary evidence. The matter is under consideration and we have full faith in the system. Justice will ultimately prevail,” he said.
Appealing for restraint, Dr. Maqbool urged the public to allow the inquiry process to reach its conclusion before drawing conclusions. “An inquiry is meant to establish facts, not to pronounce guilt before the process is complete,” he added.
Commenting on the controversy, medico and health activist Dr Mohammad Momin Khan cautioned against equating allegations with proof of wrongdoing.
“An inquiry is meant to establish facts, not deliver a verdict. Unfortunately, allegations often lead to instant public judgment, with reputations being damaged long before any investigation is completed. Due process exists to ensure fairness, and no individual should be declared guilty until the truth is established through a proper inquiry,” he said.
Dr. Momin described Dr. Maqbool as one of the Valley’s well-known cardiologists who has treated thousands of patients over the years, including many from economically weaker sections.
“If any wrongdoing is ultimately established, accountability must follow. But until then, fairness demands restraint and respect for due process,” he said.
GMC Anantnag Administrator Mukbil Lateef also said that a committee has been constituted to investigate the alleged scam, and the inquiry is currently underway. He emphasized that no individual can be declared guilty until the investigation is completed and accountability is established.
The allegations have generated widespread concern among patients, healthcare professionals and civil society groups, with many demanding a transparent, impartial and time-bound investigation and action against the doctor if really found involved in any wrongdoing and even strict action against those whose who played the reputation of the doctor if he was found innocent. (KNO)