The Central Bureau of Investigation (CBI) has uncovered a multi-crore fraud in medical reimbursement claims under the Ex-Servicemen Contributory Health Scheme booking several doctors, private hospitals and intermediaries in what officials describe as a “systematic and organised racket.” According to the agency, an FIR has been registered against Dr Vikas Sharma and Dr Rimple Gupta, directors of a private healthcare firm along with multiple hospitals and other accused persons. The role of unidentified ECHS officials is also under investigation pointing to possible internal collusion. Investigators revealed that the accused exploited loopholes in the ECHS system to generate fraudulent reimbursement claims. The modus operandi included:
- Misusing “emergency admission” provisions to bypass referral rules
- Routing patients through middlemen to select empanelled hospitals
- Fabricating prescriptions, diagnostic reports and discharge summaries
- Inflating treatment costs, pharmacy bills and hospital charges
Patients were often shown as emergency cases without proper medical justification enabling higher payouts from government funds. During searches and surprise inspections conducted earlier this year, the CBI seized:
- Fake medical files and referral documents
- Forged signatures and fabricated lab reports
- Blank letterheads, hospital stamps and digital signature tools
- Electronic evidence including WhatsApp chats
Investigators said these chats indicated prior coordination between the accused regarding admissions, discharge timing and preparation of documents suggesting post-facto fabrication of records. The probe has revealed that even non-empanelled entities were operating in collusion with empanelled hospitals by using their credentials to submit claims on the ECHS portal. In several instances, hospital desks meant for ECHS processing were allegedly being controlled by outside intermediaries indicating an unauthorised diversion of the system.
Officials also found patterns of clustered and repeated admissions where ex-servicemen beneficiaries were systematically identified and directed to specific hospitals for financial gain rather than medical necessity. The alleged scam is not limited to Chandigarh alone. Preliminary findings suggest the network extends across Punjab, Haryana, Himachal Pradesh and Chandigarh involving doctors, diagnostic centres and agents. Middlemen reportedly earned commissions for referring patients while hospitals and associated entities shared proceeds from inflated claims pointing to a well-organised financial nexus.
The CBI has invoked charges related to:
- Criminal conspiracy
- Cheating
- Forgery
- Corruption
Officials say further arrests are likely as the agency continues to examine seized evidence and identify additional individuals and institutions involved. The scam has raised serious concerns about the misuse of public funds meant for the healthcare of ex-servicemen. Authorities believe the fraud may have caused significant financial losses to the government, while also compromising genuine patient care.