When Medical Fraud Kills: India's Medical Ethics Emergency

Medical Fraud, Medical Ethics, and the Collapse of Indian Healthcare

India's healthcare sector, often celebrated globally for its low-cost medical tourism and world-class tertiary hospitals, conceals a deeply troubling underside — one defined by unnecessary surgeries, rampant medical fraud, organ transplantation rackets, pharma bribery, diagnostic commissions, and a regulatory architecture that is at once elaborate and toothless.

Parliamentary committees have openly acknowledged that the system is teetering on the edge. In the charged few minutes after a death is pronounced, the hospital corridor often becomes less a place of grief and more a courtroom without rules, with the person in the white coat cast as the most convenient villain. One may also need to contrast this with a system where over 75% of Indian doctors report having faced some form of workplace violence — each assault on one doctor quickly snowballs into mass walkouts and strikes, paralysing urgent medical care and deepening the spiral of mistrust between citizens and the very system meant to save them.

This note attempts to critically examine the full spectrum of medical fraud in India — from the structural incentives that make fraud endemic, to individual cases of breathtaking brazenness, to comparative international experiences, to the sorry state of legal accountability for wrongdoing doctors. It also examines what the failure of medical ethics at an institutional level looks like, and asks the uncomfortable question: is there a way out — including providing a safe enough work environment for doctors?

Also Read:Medical Negligence Law in India: Why Doctors Escape Accountability

A System on the Brink: Parliament's Own Warning

When a parliamentary committee acknowledges publicly that a country's healthcare system is "on the brink of collapse," it is not merely an academic observation — it is an institutional alarm bell. India's Parliamentary Standing Committee on Health and Family Welfare has issued precisely such a warning, citing chronic underfunding, staffing shortages, and inadequate research investment as structural causes of the deterioration. With nearly 30% of key health positions unfilled and the doctor-to-patient ratio languishing at around 1:1,500 to 1:1,655 against the WHO norm of 1:1,000, the systemic strain is not incidental — it is foundational. Into this vacuum of public capacity, a voracious private sector has stepped in, controlling over 80% of India's healthcare delivery, and in doing so, has transformed the healing arts into a marketplace governed not by medical ethics but by quarterly targets and kickback schedules.

India's public expenditure on healthcare stands at a mere 0.29% of GDP as of 2025–26, against the National Health Policy 2017 target of 2.5% of GDP by 2025 — a target that remains spectacularly unmet. In a devastating comparative context, India spends roughly 14–15 times less per capita on public health than BRICS nations, 10 times less than Thailand or Malaysia, and even 2.5–3 times less than Bhutan and Sri Lanka. This colossal underinvestment has created a perfect storm: desperate patients, inadequately supervised private hospitals, and a regulatory body historically more interested in approving new medical colleges than in policing practising doctors.

Also Read:Neglected Public Healthcare Centres in Gautam Buddh Nagar In Uttar Pradesh Exposed

Operating for Profit, Not Patients: The Surgery Scam

The single most explosive claim at the heart of the current discourse is that an estimated 44% of all surgeries performed in India are unnecessary or fraudulent, driven not by clinical need but by financial incentive. While this figure deserves critical scrutiny — it appears to draw significantly from second-opinion studies and insider testimony rather than randomised clinical audit — it aligns broadly with the peer-reviewed literature. A systematic scoping review published in JAMA Network Open (2023), covering over 9.1 million surgical procedures across 133 studies in low- and middle-income countries including India, found that unnecessary caesarean delivery rates ranged from 12% to 81%, and identified private financing as the primary associated factor. This is medical fraud by design — not by exception.

The granular breakdown of these figures is equally striking. A second-opinion evaluation centre in India found 55% of recommended cardiac stents and heart surgeries to be inappropriate. The World Bank, in a BMJ-published warning as early as 2014, noted that people with private voluntary health insurance in India were two to three times more likely to be hospitalised than the national average, warning that "many of these interventions deliver only marginal benefits and can actually harm patients, leading to unnecessary suffering, especially among the frail and elderly." The perverse logic is simple: under India's predominantly fee-for-service private hospital model, a doctor who recommends a surgery generates revenue; a doctor who recommends watchful waiting or lifestyle modification does not.

The book Dissenting Diagnosis (2016), authored by Dr. Arun Gadre and Dr. Abhay Shukla and based on interviews with 78 practising doctors across seven Indian cities, provides perhaps the most forensically honest insider account of this phenomenon. The doctors interviewed — from general practitioners and cardiologists to gynaecologists and surgeons — collectively describe a system where "rational and ethical medical care is

Medical Fraud, Medical Ethics, and the Collapse of Indian Healthcare

India's healthcare sector, often celebrated globally for its low-cost medical tourism and world-class tertiary hospitals, conceals a deeply troubling underside — one defined by unnecessary surgeries, rampant medical fraud, organ transplantation rackets, pharma bribery, diagnostic commissions, and a regulatory architecture that is at once elaborate and toothless.

Parliamentary committees have openly acknowledged that the system is teetering on the edge. In the charged few minutes after a death is pronounced, the hospital corridor often becomes less a place of grief and more a courtroom without rules, with the person in the white coat cast as the most convenient villain. One may also need to contrast this with a system where over 75% of Indian doctors report having faced some form of workplace violence — each assault on one doctor quickly snowballs into mass walkouts and strikes, paralysing urgent medical care and deepening the spiral of mistrust between citizens and the very system meant to save them.

This note attempts to critically examine the full spectrum of medical fraud in India — from the structural incentives that make fraud endemic, to individual cases of breathtaking brazenness, to comparative international experiences, to the sorry state of legal accountability for wrongdoing doctors. It also examines what the failure of medical ethics at an institutional level looks like, and asks the uncomfortable question: is there a way out — including providing a safe enough work environment for doctors?

Also Read:  Medical Negligence Law in India: Why Doctors Escape Accountability

A System on the Brink: Parliament's Own Warning

When a parliamentary committee acknowledges publicly that a country's healthcare system is "on the brink of collapse," it is not merely an academic observation — it is an institutional alarm bell. India's Parliamentary Standing Committee on Health and Family Welfare has issued precisely such a warning, citing chronic underfunding, staffing shortages, and inadequate research investment as structural causes of the deterioration. With nearly 30% of key health positions unfilled and the doctor-to-patient ratio languishing at around 1:1,500 to 1:1,655 against the WHO norm of 1:1,000, the systemic strain is not incidental — it is foundational. Into this vacuum of public capacity, a voracious private sector has stepped in, controlling over 80% of India's healthcare delivery, and in doing so, has transformed the healing arts into a marketplace governed not by medical ethics but by quarterly targets and kickback schedules.

India's public expenditure on healthcare stands at a mere 0.29% of GDP as of 2025–26, against the National Health Policy 2017 target of 2.5% of GDP by 2025 — a target that remains spectacularly unmet. In a devastating comparative context, India spends roughly 14–15 times less per capita on public health than BRICS nations, 10 times less than Thailand or Malaysia, and even 2.5–3 times less than Bhutan and Sri Lanka. This colossal underinvestment has created a perfect storm: desperate patients, inadequately supervised private hospitals, and a regulatory body historically more interested in approving new medical colleges than in policing practising doctors.

Also Read:  Neglected Public Healthcare Centres in Gautam Buddh Nagar In Uttar Pradesh Exposed

Operating for Profit, Not Patients: The Surgery Scam

The single most explosive claim at the heart of the current discourse is that an estimated 44% of all surgeries performed in India are unnecessary or fraudulent, driven not by clinical need but by financial incentive. While this figure deserves critical scrutiny — it appears to draw significantly from second-opinion studies and insider testimony rather than randomised clinical audit — it aligns broadly with the peer-reviewed literature. A systematic scoping review published in JAMA Network Open (2023), covering over 9.1 million surgical procedures across 133 studies in low- and middle-income countries including India, found that unnecessary caesarean delivery rates ranged from 12% to 81%, and identified private financing as the primary associated factor. This is medical fraud by design — not by exception.

The granular breakdown of these figures is equally striking. A second-opinion evaluation centre in India found 55% of recommended cardiac stents and heart surgeries to be inappropriate. The World Bank, in a BMJ-published warning as early as 2014, noted that people with private voluntary health insurance in India were two to three times more likely to be hospitalised than the national average, warning that "many of these interventions deliver only marginal benefits and can actually harm patients, leading to unnecessary suffering, especially among the frail and elderly." The perverse logic is simple: under India's predominantly fee-for-service private hospital model, a doctor who recommends a surgery generates revenue; a doctor who recommends watchful waiting or lifestyle modification does not.

The book Dissenting Diagnosis (2016), authored by Dr. Arun Gadre and Dr. Abhay Shukla and based on interviews with 78 practising doctors across seven Indian cities, provides perhaps the most forensically honest insider account of this phenomenon. The doctors interviewed — from general practitioners and cardiologists to gynaecologists and surgeons — collectively describe a system where "rational and ethical medical care is becoming increasingly rare," where honest doctors feel "under siege," and where the influence of the pharmaceutical industry has become "even more pervasive." Crucially, several practitioners confirmed that they felt pressure to recommend unnecessary interventions or face termination or loss of referrals from corporate hospitals. The wholesale abandonment of medical ethics in corporate hospital settings is not the story of a few bad apples — it is the story of a corrupted orchard.

Senior doctors in large hospitals in Maharashtra reportedly earn salaries touching ₹1 crore per month — not because of their medical expertise alone, but because their ability to push patients into unnecessary tests, admissions, and surgeries makes them extraordinarily profitable to their employers. This "target-based" medical practice is the corporatisation of healthcare reduced to its most brutal logical endpoint.

Also Read:  Medical Negligence in Tata Motors Hospital Killed My Sister - Brother

Ayushman Bharat and the Insurance Fraud Catastrophe

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), India's flagship government health insurance scheme, has become a textbook case of how well-intentioned social policy can be systematically exploited through medical fraud. The National Anti-Fraud Unit processed 6.66 crore claims, of which 2.7 lakh claims from private hospitals — amounting to Rs 562.4 crore — were found inadmissible due to abuse, misuse, or incorrect entries. Punjab, Haryana, and Himachal Pradesh alone accounted for Rs 74.5 crore of these fraudulent claims.

The scale of the government's own response tells the story of how entrenched the fraud became. As of 2025, the Union government had de-empanelled 1,114 hospitals, suspended 549 more, imposed penalties of Rs 122 crore on 1,504 hospitals, and rejected 3.56 lakh fraudulent claims amounting to Rs 643 crore. While the government rightly touts these figures as evidence of a "zero-tolerance policy," the numbers also reveal that hundreds of thousands of fraudulent transactions were successfully submitted — and in many cases paid — before detection.

The fraud mechanism is elegant in its simplicity: hospitals swipe the smart cards of enrolled beneficiaries, bill for treatments never rendered, inflate codes to claim costlier procedures, or in the most brazen instances, claim treatment for patients who are not even admitted. Multiple cases have been reported where patients with colds or minor ailments were enrolled under Ayushman Bharat and billed for expensive surgeries — hospitals pocketing the money and patients sometimes paid a small sum to cooperate.

The medical fraud is not confined to government schemes. Private mediclaim policies suffer equally. Over 3,000 reputed hospitals have reportedly been blacklisted by major insurance companies for false claims. The abuse during COVID-19, when hospitals across India are alleged to have claimed insurance for fake or inflated COVID cases, represents possibly the most callous exploitation of a public health emergency in India's modern history.

Also Read:  Ayushman Bharat Works on Paper. Ground Reality Tells Different Story.

Ventilators on the Dead: Fraud at Its Most Barbaric

Among the darkest categories of medical fraud documented in India is the ventilator fraud — the practice of keeping deceased patients on life support in order to continue billing their families or insurance providers. Cases reported in the media describe instances where clinically dead patients were placed on ventilators and declared alive for days or weeks before families were told the truth. In one well-documented case, a 14-year-old boy who had already died was kept on a ventilator for a month — hospitals extracting billing during this entire period — before finally being declared dead. After complaints, the hospital paid a Rs 5 lakh settlement. That settlement, derisory in comparison to the emotional devastation wrought on the family, also epitomises the inadequacy of current accountability mechanisms.

The reported practice of performing fake "emergency surgeries" on already-deceased patients — collecting surgery costs before informing families of the death, with the explanation that the patient "died on the table" — is documented in Dissenting Diagnosis as a known, if rarely acknowledged, occurrence. These cases sit at the intersection of medical fraud, conspiracy, and moral barbarism, yet the perpetrators face minimal criminal consequences. Medical ethics, in these instances, has not merely been stretched — it has been obliterated.

Also Read:  Jaslok Hospital: "Punctured Lungs, Trial Drug & Errors Killed My Wife"

The Organ Trafficking Underworld: A Multi-Crore Industry

India's organ trafficking problem is not new, but its reach and sophistication have deepened alarmingly. The Transplantation of Human Organs and Tissues Act, 1994 (THOTA) prohibits commercial organ trade and restricts donation to relatives or emotionally connected donors approved by state authorisation committees. However, trafficking networks have developed elaborate methods to bypass these provisions — fabricating family trees, forging notary certificates, manipulating DNA test results, and bribing transplant coordinators and hospital staff.

The case of Pushpawati Singhania Hospital CEO Deepak Shukla, arrested in 2019 for running an international kidney racket involving at least 13 suspects and multiple Delhi hospitals, underscored just how high up institutional complicity can reach. The Hiranandani Hospital case in Mumbai in 2016, where the CEO, medical director, and three doctors were arrested for trafficking kidneys from poor rural women sold as "wives" of recipients via forged marriage documents, implicated a prestigious institution at the highest levels. The 2024–25 Jaipur–Rajasthan case, involving an interstate and international trafficking network that lured Bangladeshi nationals with promises of money for kidneys using forged documents and fake identities, further confirms that this is an organised transnational crime. The Rachakonda police, in early 2025, busted a ring operating out of Alakananda Hospital in Hyderabad, arresting nine accused including two doctors, with allegations of operations running since at least 2023.

That apart, the media has reported fresh 2024 cases of kidney trafficking involving patients from Bangladesh brought to Delhi under fraudulent documentation, with one Delhi surgeon arrested for her role in the network. Al Jazeera's 2025 investigation into a "village of one kidney" — where impoverished Bangladeshis described being recruited, transported, operated upon, and sent home — highlighted how poverty is systematically weaponised by brokers who stand between desperate recipients and equally desperate donors.

The Union Health Ministry, alarmed by the Jaipur case, directed all states and Union Territories in April 2024 to investigate violations and mandated generation of a unique NOTTO-ID for all transplant cases — a belated but necessary step. However, the enforcement capacity of state "Appropriate Authorities" under THOTA remains woefully inadequate.

Also Read:  The Underworld of Organ Transplantation in India

Patients as Commodities: The Referral Scam

The referral commission system — where general practitioners and smaller clinics are financially rewarded by large hospitals for every patient sent their way — has become so normalised in India as to be practically an open secret. A reputed top-end private hospital in Mumbai reportedly once published an explicit payment schedule: Rs 1 lakh for sending 40 patients annually, Rs 1.5 lakh for 50, and Rs 2.5 lakh for 75 patients — irrespective of whether those patients had genuine clinical need.

Apollo, Fortis, Apex, and other brand-name hospital chains are alleged to be operating similar informal programmes. The consequences for patients are severe: they are subjected to the scrutiny and protocols of large tertiary hospitals for conditions that could be managed far more cost-effectively at primary or secondary care levels, while simultaneously being exposed to upselling of unnecessary investigations and interventions. The patient is not merely a human being seeking care — they are a revenue unit in a supply chain that begins at the neighbourhood clinic and ends in the operating theatre. Medical ethics has no place in this calculus.

The Diagnosis Scam: 200,000 Labs and Almost No Oversight

India has approximately 200,000 diagnostic laboratories across the country, of which only approximately 1,000 are certified by recognised quality bodies. This extraordinary gap between the number of labs and quality-verified ones creates an almost regulation-free environment where results can be manipulated, tests fabricated, and commissions freely exchanged.

Income Tax raids on reputed pathology labs in Bengaluru reportedly uncovered over Rs 100 crore in cash and 3.5 kg of gold kept aside as doctor commissions — rewards for routing patients toward those labs for tests, many of which are unnecessary. Doctors reportedly earn 40–50% commissions for such referrals, creating a powerful financial incentive to over-investigate.

The National Pharmaceutical Pricing Authority (NPPA), India's drug price regulator, found in a 2018 investigation that diagnostic services at major Delhi-NCR private hospitals were "invariably higher" than those charged at independent private centres — evidence that the hospital-lab nexus profits both from over-referral and over-charging once the referral is made.

Pharma Bribes and the Freebie Economy

The pharmaceutical industry's relationship with India's medical community is one of the best-documented examples of structural corruption in any professional sector. Around 20–25 major pharmaceutical companies collectively spend approximately Rs 1,000 crore per year on doctor incentives — ranging from cash and foreign travel to luxury hotel stays and conference sponsorships.

The Dolo-650 case became a landmark exposure: after the Central Board of Direct Taxes (CBDT) raided 36 premises of Micro Labs Ltd. in July 2022, it alleged that the manufacturer of Dolo-650 had distributed freebies worth approximately Rs 1,000 crore to doctors during the COVID-19 pandemic to incentivise prescription of its 650mg tablet — a formulation deliberately kept above the 500mg price control ceiling to maximise profit margins. The Supreme Court bench led by Justice DY Chandrachud called it "a serious issue" and noted that such practices directly endanger patients' fundamental right to health.

The drug pricing markup scandal runs parallel to the bribery crisis. Another media investigation documented pharmaceutical company quotations offering Emcure's Temicure 250mg to hospitals at Rs 1,950, while patients were billed Rs 18,647 — a nearly ninefold markup. Reliance Life Sciences offered its cancer drug Trasturel 440mg to hospitals at Rs 30,875; patients paid Rs 58,602. Abbott offered heart drugs to hospitals at roughly one-third of MRP. The NPPA investigation found trade margins on some hospital consumables as high as 2,100% — one injection bought for Rs 13.64 and billed to patients at Rs 189.95. The regulator's own report noted that it lacked jurisdiction to take action against hospitals for such overcharging — a damning admission of regulatory impotence by design.

Also Read:  Medical Negligence: “It Took 15 Years and $5M to Get Justice in India"

Laws Without Teeth: India's Broken Regulatory Architecture

India's regulatory framework for healthcare is a labyrinth of overlapping legislation — the Indian Medical Council Act 1956 (now replaced), the Clinical Establishments (Registration and Regulation) Act 2010 (CEA), the Consumer Protection Act 2019, the THOTA 1994, and the NMC Act 2019 — that collectively produces elaborate paper compliance and minimal real-world accountability.

The CEA 2010 was Parliament's landmark attempt to standardise healthcare regulation nationally. Fourteen years after its passage, it remains effectively unimplemented. Only 12 states have adopted it, none has implemented it properly, minimum standard notifications expected by 2014 have still not been finalised, and hospital associations have challenged in the Supreme Court the Centre's very authority to regulate private hospital pricing.

A 2025 policy analysis in the Integrated Journal for Research in Arts and Humanities identified eight critical implementation gaps — including federalism challenges, absent patient protection mechanisms, weak enforcement, disproportionate burdens on smaller providers, and digital integration failures.

The Medical Council of India (MCI) itself was dissolved in 2020 precisely because of its notorious corruption — members elected by the regulated profession, arbitrary decisions, opaque functioning, and allegations of freely issuing approvals to substandard medical colleges in exchange for considerations. Its successor, the National Medical Commission (NMC), established under the NMC Act 2019, was meant to be transformative. Yet a damning RTI response in January 2026 revealed that between its inception in September 2020 and January 2026, the NMC had taken up 185 appeals filed by doctors while rejecting all 256 appeals filed by patients — effectively converting itself into a doctors' protection bureau rather than a patient-safety regulator. The NMC only resolved in September 2024 to begin entertaining patient appeals — and even this decision has not been made publicly available. As health policy researcher Dr. KV Babu documented, the NMC was rejecting, on average, one patient appeal every week for five years. It is difficult to imagine a more complete institutional abandonment of medical ethics.

Under the NMC framework, professional misconduct regulations exist, but enforcement by state medical councils is notoriously weak. Rules requiring doctors to prescribe only generic (salt) names, to disclose full fees before treatment, to obtain informed consent, and to maintain records for three years are systematically violated. The gap between regulatory text and ground reality has never been wider.

Also Read:  NMC: Exposing How It Is Failing Patients and Shielding Doctors

The Elusive Penalty: How Few Doctors Are Ever Held Accountable

How many Indian doctors have actually been penalised — criminally or monetarily — for medical fraud or gross negligence? The honest answer is: very few, relative to the scale of documented wrongdoing.

Criminal prosecution of doctors in India operates under Section 304A of the Indian Penal Code (causing death by negligence). The Supreme Court's landmark 2005 judgment in Jacob Mathew v. State of Punjab established that criminal liability arises only in cases of "gross negligence" amounting to recklessness, adopting the English "Bolam Test" — which protects doctors if they act in accordance with a responsible body of medical opinion. While this standard appropriately protects doctors from vexatious complaints, it has also, in practice, raised the evidentiary bar so high that very few criminal prosecutions against doctors succeed. Courts have further required, as a precondition for criminal prosecution, an independent medical opinion from a credible panel — a requirement that itself depends on doctors opining against fellow doctors, a prospect the medical fraternity consistently resists.

On the civil side, the Indian Supreme Court's award of Rs 11 crore compensation in one landmark medical negligence case represented the highest sum ever awarded in Indian medical negligence history at the time — but the judgment itself noted that compensation calculation "is unpredictable as it varies hugely across different cases, courts and tribunals." This unpredictability itself discourages complainants. As of 2025, India saw 65,000 medical negligence cases filed annually across state High Courts, the Supreme Court, and NCDRC — a sharp rise in litigation, with paperwork lapses and administrative failures now driving more cases than clinical errors.

For government insurance scheme fraud, the enforcement record is mixed. Under AB-PMJAY, 1,184 hospitals have been de-empanelled and penalties of over Rs 231 crore levied. But de-empanelment without criminal prosecution means hospitals can reconstitute under different names and return — a revolving door that is well documented, including in Gujarat where 19 previously blacklisted hospitals were allowed to resume operations after nominal compliance.

For organ trafficking, sentences under THOTA remain relatively light given the gravity of the offence, and state Appropriate Authorities tasked with enforcement are routinely understaffed and under-resourced. The long-running Jaipur kidney trafficking case has seen accused secure bail after delays of two years — a pattern consistent with India's broader criminal justice bottleneck.

Also Read:  Delhi High Court Flags Regulatory Failures at Saroj Hospital | The Probe Impact

Not an Indian Exceptionalism: Global Comparisons

It is important to resist the temptation to frame India's medical crisis as uniquely aberrant. Healthcare fraud is a global phenomenon, and its contours in developed nations offer both comparative perspective and cautionary lessons.

In the United States, healthcare fraud is estimated to cost between USD 100 billion and USD 170 billion annually — accounting for 3% to 15% of total healthcare spending. A 2017 analysis in BMC Health Services Research examined unnecessary invasive procedures in the US, finding evidence of widespread overuse across surgical specialities. Hospital billing fraud — the practice of billing for services not rendered, "upcoding" to claim more expensive procedures, and ghost billing — costs the US Medicare and Medicaid system billions each year, and the FBI and Department of Justice run dedicated healthcare fraud enforcement units that have secured billions in recoveries and hundreds of criminal convictions. The False Claims Act provides qui tam provisions allowing whistleblowers to sue on behalf of the government — a powerful enforcement mechanism entirely absent in India.

In the United Kingdom, NHS England faces approximately 12,000 medicolegal claims annually at a combined cost of GBP 8 billion — representing 6.7% of the NHS England budget. The UK's regulatory regime, anchored by the General Medical Council (GMC) which operates independently and has the power to strike doctors from the medical register, provides a considerably more robust accountability mechanism. However, even the NHS was not immune to COVID-era fraud, with the Department for Health and Social Care estimating GBP 324 million in PPE fraud alone.

Why Medical Fraud Became Endemic: The Structural Roots

Understanding India's medical crisis requires moving beyond individual bad actors to examine the structural conditions that make medical fraud rational, rewarding, and low-risk.

The first structural driver is the near-total dominance of out-of-pocket healthcare spending. India's patients pay for most of their care themselves, with inadequate consumer protection, no price transparency requirements that are actually enforced, and deeply asymmetric information between provider and patient. When a doctor tells a semi-literate patient from rural Uttar Pradesh that their child needs an emergency laparotomy, there is no mechanism by which that patient can evaluate the advice, seek a quick second opinion, or refuse without risking their child's life.

The second structural driver is the commercial hospital model's incentive architecture. Target-based salaries, revenue-linked departmental budgets, and hospital rankings that reward volume over outcome create an environment where the financial rewards for over-treatment far exceed those for appropriate treatment. Senior hospital administrators, whose own compensation is tied to hospital profitability, look the other way. Medical ethics is, in this model, a commercial liability.

The third driver is the regulatory paralysis described above — a Clinical Establishments Act that exists on paper but not in practice, a National Medical Commission that until 2024 refused to hear patient complaints, and a pharmaceutical marketing code that remains voluntary and therefore irrelevant.

The fourth driver, rarely discussed, is the criminal-political nexus that protects many of these operations — one that makes the enforcement of medical ethics practically impossible in affected areas. Reports of collusion between police, hospital staff, and organ trafficking networks have been documented in multiple cases. ESI and Ayushman Bharat fraud cases involving inflated bills approved by corrupt government officials have been reported across multiple states.

Prescription for a Sick System: The Way Forward

The path forward is neither politically simple nor fiscally painless, but its broad outlines are reasonably clear from the global evidence on healthcare system reform.

First, the Government needs to immediately operationalise the Clinical Establishments Act (CEA) 2010 with mandatory price transparency, standardised treatment protocols, and enforceable minimum standards. The current situation — where draft standards issued in 2019 have still not been made permanent in 2025 — is simply inexcusable. Simultaneously, the Government must develop a Uniform Code of Pharmaceutical Marketing Practices with statutory teeth and criminal penalties for violation, as petitioned before the Supreme Court. The voluntary nature of the existing code makes it a dead letter.

Second, India needs an independent, adequately resourced patient ombudsman with suo motu investigative powers — analogous to the GMC's fitness-to-practise investigations in the UK — to review cases of suspected medical fraud, over-treatment, and institutional misconduct without depending on patients to navigate a hostile complaints ecosystem.

Third, the NMC's Ethics and Medical Registration Board must be genuinely empowered to hear and adjudicate patient complaints, strike off serial offenders from the medical register, and publish findings transparently. Restoring the centrality of medical ethics to the NMC's mandate requires statutory amendment to the NMC Act 2019, not merely internal board resolutions.

Fourth, the Transplantation of Human Organs and Tissues Act needs comprehensive revision — strengthening penalties, mandating national data reporting through NOTTO for every case, and providing enforcement resources to state Appropriate Authorities that currently exist in name only.

Fifth, and most fundamentally, India must fulfil its National Health Policy commitment to spend 2.5% of GDP on public health. The corrosive private sector dominance of Indian healthcare is in no small part a consequence of the state's abdication of its primary responsibility to deliver universal healthcare. As long as public health spending per capita remains among the lowest in the world, patients will remain desperate, vulnerable, and at the mercy of a private system that has little structural incentive to uphold medical ethics.