Doctor Suspended Over Alleged Insurance Fraud Scheme

Authorities in J&K ordered an inquiry and suspended an interventional cardiologist, Dr. Syed Maqbool, on Saturday. He is accused of recording 103 advanced pacemaker procedures under the Ayushman Bharat PMJAY category, which reportedly did not cover them. This allegedly allowed patients to claim government insurance benefits for procedures not included in the scheme.

An internal report suggests Dr. Maqbool, an associate professor at Govt Medical College in Anantnag, recorded "left bundle branch area pacing" (LBBAP) procedures as dual-chamber pacemaker implantations. Medical laboratory records reportedly indicated patients underwent the advanced LBBAP technique rather than conventional pacemaker implantation.

Dr. Maqbool has rejected the allegations, stating that all claims have been answered with documentary evidence. The suspension has prompted a broader discussion within the medical community regarding the LBBAP technique, a newer method offering potentially better clinical outcomes than traditional pacing. Doctors note that Ayushman Bharat did not cover LBBAP, leading some to use the dual-chamber category to secure insurance support for patients.

Under this arrangement, Ayushman Bharat covered partial costs, with patients directly paying private suppliers for specialized LBBAP hardware. Without this workaround, patients would have incurred the full cost themselves. Experts acknowledge the benefits of LBBAP, with some advocating for its routine use in patients requiring dual-chamber pacemakers due to its advantages and comparable safety profile.