System introduced from July 15 curbs unnecessary diagnostic tests; TMS of nine hospitals and IDs of three doctors blocked over irregularities
Jaipur, Sept 2026 : The pre-authorisation system introduced under the Rajasthan Government Health Scheme (RGHS) to enhance transparency and curb unnecessary diagnostic tests has resulted in a 47 per cent reduction in claims, according to the state government.
The system, implemented from July 15, makes pre-authorisation mandatory for diagnostic tests costing more than Rs 2,000. Digital monitoring of hospitals and doctors has also been strengthened, with action being taken against healthcare providers where suspicious activities or irregularities are detected.
Principal Secretary, Medical and Health, Gayatri Rathore said ensuring quality treatment for patients while enforcing compliance with RGHS provisions remains a priority of the department. She said prescriptions, diagnostic tests and claim-related activities are being continuously monitored and action will be taken according to rules wherever irregularities are found.
RGHS Chief Executive Officer Harjilal Atal said the activities of hospitals and doctors are being monitored through digital systems. The pre-authorisation mechanism has helped in effectively controlling unnecessary tests and claims, while suspicious cases are being investigated for appropriate action.
RGHS Project Officer Dr Nidhi Patel said a 47 per cent decline in claims has been recorded since the pre-authorisation system came into effect on July 15.
She said monitoring revealed instances where diagnostic tests were being prescribed on different days instead of the same day, apparently to keep individual tests outside the Rs 2,000 threshold requiring pre-authorisation. In some cases, patients were asked to visit hospitals repeatedly over a period of three days for tests prescribed on different dates, requiring them to make two or three hospital visits in the same week.
Digital monitoring is being used to identify such patterns, which can cause inconvenience to patients and affect the prescribed procedure under the scheme. Action is being taken based on investigations into such cases.
As part of the action, the Treatment Management System (TMS) access of nine hospitals and the doctor IDs of three doctors have been blocked.
In Kota, the TMS access of two hospitals was blocked after investigations found that the same doctor had reportedly worked at both hospitals on the same day. The doctor’s ID was also blocked in the matter.
In Alwar, prescriptions issued in the name of a doctor at one hospital were found to have different handwriting and signatures. At another Alwar hospital, several OPD prescriptions showed a similar pattern in the doctor’s seal and signature. At a Jodhpur hospital, two different handwriting styles and two distinct signature patterns were found on prescriptions issued in a doctor’s name.
In Dausa, one hospital was found prescribing diagnostic tests without adequate clinical findings or justification and recommending more tests than considered necessary. Another hospital in the district was found to have discrepancies between signatures on digital prescriptions and manual prescriptions, along with other irregularities.
At an Alwar hospital, polyethylene glycol was prescribed in around 65 cases, with no relevant clinical indication recorded in several cases. Serum iron tests were also prescribed in multiple cases without clear symptoms, clinical findings or diagnosis.
The doctor ID associated with a Bikaner hospital was also blocked after repeated prescriptions of similar diagnostic tests were reportedly found despite complaints from different patients.
The ID of a doctor associated with a Jaipur hospital was blocked after different handwriting was detected in prescriptions. The TMS of a Udaipur hospital was also blocked in connection with various cases.
The government said the action is aimed at maintaining transparency throughout the treatment and claims process under RGHS, preventing unnecessary diagnostic tests and protecting the interests of beneficiaries.
