Pacemaker procedures, PMJAY funds, and a top Kashmir cardiologist facing suspension

The Jammu and Kashmir government has suspended a prominent cardiologist over allegations that he misrepresented pacemaker procedures to “siphon public welfare funds” from the Prime Minister’s Jan Arogya Yojana (PMJAY) health insurance scheme — charges he denies and that have divided the wider medical fraternity in the Union Territory.

In its suspension order dated Saturday, the J&K government’s health department accused Dr Syed Maqbool of “intentional misrepresentation, serious data falsification, and financial fraud”. It also alleged that Dr Maqbool forced “vulnerable patients to pay out-of-pocket expenses”, deliberately bypassing the institutional supply chain network and performing “highly advanced invasive procedures on patients without any clinical justification”.

“Pending inquiry into his conduct, Dr Syed Maqbool Ahmad Shah, Associate Professor Cardiology presently deputed at Government Medical College Anantnag, is hereby placed under suspension with immediate effect in terms of rule 31 of Jammu and Kashmir Civil Services (Classification, Control and Appeal) Rules 1956,” Commissioner Secretary to Government M Raju said in the order. “During the period of his suspension, he shall remain attached (to) the Office of Medical College Jammu.”

Dr Maqbool denied the allegations, saying he had submitted his response with documentary evidence. The accusations also sparked a wider debate in the medical fraternity, with some calling the claims an outcome of internal politics.

The allegations

The allegations concern the Left Bundle Branch Area Pacing (LBBAP) procedure, a newer pacemaker technique in which a lead is placed deep within the heart’s septum to stimulate its natural electrical pathways and produce a more physiological heartbeat.

While standard dual-chamber pacemaker implantation is covered under PMJAY, LBBAP — an advanced form of pacemaker implantation — is not. The government order alleges that Dr Maqbool falsely booked patients under the dual-chamber pacemaker package on the PMJAY portal even though they had undergone LBBAP procedures.

Saturday’s suspension came days after the government initiated the probe against Dr Maqbool on June 12.

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In its probe order, the government said that Dr Maqbool booked 103 cases on the Transaction Management System (TMS) under the “Dual Chamber Pacemaker Implantation” package under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) health insurance scheme. The procedure involves implanting a pacemaker to regulate the heart’s rhythm.

“Physical records prove you have actually performed LBBAP. This intentional misrepresentation was designed to siphon public welfare funds from the PMJAY/SEHAT scheme under a false clinical pretext,” reads the probe order. “You directly violated the absolute cashless and free mandate of the PMJAY/SEHAT scheme and forced vulnerable patients to pay out-of-pocket expenses for procedures done within a government facility.”

The probe order cited a case in which a patient was allegedly “coerced into paying Rs 70,000 to a private company”.

The memorandum of allegations further accused the cardiologist of bypassing the “institutional supply chain network”. “You failed to source required medical hardware through the mandatory path and instead illegally collaborated with private external vendors, effectively destroying hospital transparency, quality control and accountability protocols,” reads the order.

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“An independent expert evaluation showed that out of 55 evaluated LBBAP cases, 27 patients (49%) had completely normal left ventricular function and wide QRS morphology. Performing such procedures on patients shows a complete disregard for patient safety,” it stated.

The response

Speaking to The Indian Express, Dr Maqbool said that with a dual-chamber pacemaker, there’s a 20 per cent chance of failure within six months to three years.

“And to overcome it, the LBBAP is the advanced procedure that is being implemented worldwide,” he said. “In both cases, two wires are put. In dual chamber, we put it in the heart muscle, while in LBBAP, we put it in the heart’s conduction system.”

He denied allegations that the institutional supply chain was bypassed, saying that every purchase was made through the government-run Amrit store. “All these procedures were conducted free and cashless under the PMJAY,” he said. “There were exceptional cases where the patients had to put some of their own money; even those purchases were done through Amrit.”

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He said lab tests alone do not decide the necessity of cardiac procedures and that certain indications play an important role in doctors’ decision-making.

A fraternity divided

Within the medical fraternity, some called the development a fallout of internal politics. “He (Dr Maqbool) is the one who is being credited for setting up an efficient and advanced cardiac unit in GMC Anantnag,” a senior doctor said. “His performance and growing clout did not go down well with some people.”

“The people who have conducted this investigation don’t understand or have any knowledge of the field of left bundle area pacing,” a US-based Kashmiri cardiologist, Dr Khalil Kanjwal, posted on X. “All our patients who come to my lab for a dual chamber pacemaker receive left bundle pacemaker. The investigators of this alleged fraud have made themselves a laughing stock.”

But another doctor disagreed, saying the cardiologist went against PMJAY guidelines. “Irrespective of the fact whether advanced procedures were needed or not, he has violated the guidelines issued in PMJAY,” said the doctor. “We need to wait for the decision of the probe committee.”