India’s healthcare system is not merely sick — it is bleeding from a thousand deliberate cuts, many inflicted by the very hands meant to hell. Parliamentary standing committee has itself declared the sector to be in near-collapse, and the Evidence now spilling out from Investigative reports, income-tax raids, whistle-blower accounts and court-ordered inquiries is so damning that it is impossible to dismiss as isolated rot.

Almost half of all surgeries performed in India — 44% according to a deeply researched Zee News investigation — are either fraudulent, entirely unnecessary or performed solely to extract money from patients, insurance companies or government schemes. Over half of all cardiac procedures (55%), almost half of hysterectomies and knee replacements (48% each), 47% of cancer surgeries and 45% of Caesarean sections fall into this category. In plain language, every second time an Indian is wheeled into an operating theatre, there is a coin toss whether the knife is medically justified or simply a tool for looting.

The incentive structure that drives this carnage is brutally simple. In Maharashtra’s top private hospitals, senior surgeons are paid up to one crore rupees a month, not for their skill but for their ability to generate bills — the more tests ordered, the more admissions engineered, the more surgeries pushed ( Weather needed or not), the fatter the paycheck. BMJ Global Health has documented this target-based remuneration model in chilling detail. Medicine has been financialised to the point where a doctor’s income is directly proportional to the degree of overtreatment he can inflict.

The Cruelty does not stop at the living. The Times of India and the book Dissenting Diagnosis by Dr Arun Gadre and Dr Abhay Shukla have recorded multiple verified cases of hospitals keeping dead bodies on ventilators for weeks, performing fake surgeries on corps, and presenting enormous bills to shattered families who are too numb to protest. In one case that reached the consumer court, a reputed hospital kept a 14-year-old boy — already dead on arrival — on life support for a full month before “declaring” him dead and reluctantly paying five lakh rupees as compensation after being found guilty. The mental torture inflicted on the family was, of course, uncompensated and unacknowledged.

Health insurance, sold to the middle class as a safety net, has become another theatre of plunder. Roughly 68% of Indians now have some form of coverage, yet claims are rejected or partially honoured with such regularity that six out of ten hospitalised families still fall into debt. Over three thousand reputed hospitals stand blacklisted by insurance companies for fraudulent billing, a number that skyrocketed during the COVID years when fake admissions and invented complications became an industry-wide sport.

Organ trafficking, once thought to be the stuff of thriller novels, operations with terrifying openness inside some of India’s best-known corporate chains. The Indian Express investigation that exposed the 2019 Fortis-Delhi racket showed how poor women and migrant workers are lured with job offers, admitted for "routine check-ups" and wake up (if they wake up at all) minus a kidney. The involvement of doctors, nursing staff, ambulance drivers and even police officers in these networks reveals a criminal ecosystem protected by money and influence.

Referral commissions have been institutionalised to the point of advertisement. Kokilaben Hospital in Mumbai once circulated an open rate card: send us 40 patients and earn one lakh rupees, 50 patients for one-and-a-half lakhs, 75 patients for two-and-a-half lakhs — no questions asked about medical necessity. Apollo, Fortis and other chains run similar "doctor loyalty programmes" that reward the volume of human bodies delivered, not the quality of care rendered.

Diagnostic fraud runs into hundreds of crores every year. When income-tax officials raided a single pathology chain in Bengaluru, they recovered a hundred crore rupees in unaccounted cash and 3.5 kilograms of gold kept aside exclusively for doctor kickbacks. India has more than two lakh diagnostic laboratories but barely a thousand are accredited; the rest are free to fabricate reports, conduct tests only on paper, and split the proceeds 50-50 with the prescribing physician.

Pharmaceutical companies are equal partners in the loot. Twenty to twenty-five large firms admit to spending a thousand crore rupees annually on “marketing expenses” — code for cash, foreign holidays, five-star conferences and direct deposits into doctors’ accounts to ensure their brand is prescribed even when cheaper, equally effective generics exist. The Dolo-650 scandal during the pandemic and the open bragging by companies such as USV Ltd (three lakh rupees cash or an all-expenses-paid trip to Australia per doctor) show how naked the bribery has become.

Inside hospitals, the overpricing is astronomical. India Today’s sting operations found cancer injections supplied to hospitals at ₹1,950 being billed to patients at ₹18,645 — a markup of nearly 850%. Stents, implants and consumables follow the same pattern: Bought cheap in bulk, sold at whatever the market desperation) will bear.

The regulator that is supposed to stop all this — first the Medical Council of India and now its successor, The National Medical Commission — has been described in an official parliamentary report as “completely failed” in its duty to control errant doctors and hospitals while remaining hyperactive in granting permissions to open new medical colleges (often in exchange for bribes). Basic ethical rules — prescribe only generics, declare your fees upfront, take informed consent, maintain records for three years, report unique colleagues — exist only on paper.

Even government-funded healthcare is deeply compromised. Ex-servicemen, CGHS beneficiaries and Ayushman Bharat cardholders are routinely admitted for trivial complaints, kept for weeks, subjected to unnecessary procedures, and discharged only after fictitious bills running into lakhs have been generated and split between hospital management and complicit officials.

What we are witnessing is not a healthcare system with a few bad apples; it is a thriving criminal enterprise wearing the white coat of medicine. The crisis is structural, cultural and moral. Until volume-based incentives are replaced by outcome-based rewards, until regulators acquire and independence, until whistle-blowers are protected instead of persecuted, and until the political class stops treating private healthcare chains as cash cows for electoral funding, the plunder will continue.

India can no longer afford to look away. A nation that allows half its surgeries to be fake, its dead to be billed, its poor to be harvested for organs and its middle class to be driven into debt by the very institutions meant to cure them is a nation that has lost its soul. The operating theatre has become a slaughterhouse of greed, and the patient, sedated and trusting, is paying with money, organs and life itself. The time for polite concern is over; what is required now is outrage, accountability and radical, unflinching reform.