Corruption in India's private medical industry is not exactly unheard of. But the arc lights have again been cast on the murky dealings.

Last month, an article in the British Medical Journal ( BMJ) highlighted the "capitation" fees that many private medical colleges demand for admission. And in a BMJ article last year, Samiran Nundy, head of the department of surgical gastroenterology and organ transplantation, Sir Ganga Ram Hospital, Delhi, and editor-in-chief, Current Medicine Research and Practice, said that corruption was all pervasive in India's healthcare industry - and that it starts with capitation fees.

Indeed, many private medical institutes have been charging students seeking to study medicine hefty capitation fees, despite a Supreme Court ban on selling seats. Medical activists say the figures involved are mind boggling.

Dr Sunita Banerjee (name changed), a consulting hospital administrator, rues just that. She managed to get both her sons admitted to private medical colleges in Karnataka a few years ago. "I paid capitation fees to the tune of several lakh rupees," she says. Banerjee had to sell her ornaments and mortgage her house to raise the money.

"In 2014, the capitation fees paid to private colleges totalled Rs 60 billion," says Nundy. He gets these numbers from a National Institute of Public Finance and Policy report published last year - it ranked India's private education sector as the second biggest generator of black money in the country.

But voices are now being raised against the practice. The BMJ has suggested that barring students of such colleges from training in hospitals abroad may help in the fight against capitation fees. But in India, there is little consternation about the hundreds of students who graduate every year after buying seats in colleges.

To study in a particular private medical college in Meerut, for instance, you pay as much as you would at Harvard in the US. Last year, a television channel conducted a sting operation on the underhand admission practices there, says Sumanth Raman, a Chennai-based senior medical consultant in critical care. "The director was caught on camera demanding Rs 60 lakh for admission to a medical diploma course," he says. The amount didn't include admission or tuition fees.

There's an unwritten but strictly-adhered-to rate list, especially for private medical colleges in Maharashtra, Karnataka and Tamil Nadu, holds P. Zachariah, former head of the department of physiology, Christian Medical College, Vellore. The rate for an MBBS degree programme is between Rs 30 lakh and Rs 60 lakh. Postgraduate courses cost twice as much. "Sought-after PG courses, like radiology or cardiology, cost upwards of Rs 1.5 crore," he adds.

Getting a medical degree in India is, clearly, leaving many people's finances in a critical condition. "India has less than one doctor per 1,000 population. The high demand for healthcare professionals has made the selling of medical education big business," Raman rues.

With the 2015 admission season around the corner, the cash-for-seat trend will only soar higher, predicts Nundy, thanks to the Medical Council of India's (MCI) move to shut 10 private colleges in June.

A spokesperson for the Delhi-based medical regulatory body says the colleges were shut because they didn't have the required faculty strength and lacked adequate infrastructure. "Finding faculty has become a huge challenge for medical colleges. Doctors don't want to teach because medical practice is more paying," she says.

But for India's eight lakh aspiring doctors - who will appear for the All India Pre-Medical Test (AIPMT) this year - the MCI diktat translates into 6,390 fewer MBBS seats to compete for. "With the MCI scrapping more colleges, capitation fees are expected to go further up," Nundy warns.

In 2014, the MCI had 398 medical colleges on its list, with a total annual intake of 52,105 seats. Of these 398 institutes, 215 were private colleges.

A 2010 global report by the Foundation of Advancement of International Medical Education found that India has the highest number of medical schools in the world. "[But] In India, the growth of private medical schools raises concerns about the quality and transparency of one of the world's largest medical educational systems," the report says.

Mumbai-based journalist Jeetha D'Silva, who wrote the scathing report in January in BMJ, says she didn't have to look too deep to figure how the capitation fee payment network works. "Most colleges work with agents - who liaise with students and collect the money," the journalist says.

Officials, however, deny that seats are given out of turn to students with deep pockets. A spokesperson for the Association of Managements of Unaided Private Medical and Dental Colleges in Maharashtra says the association conducts a state-wide common entrance test and admissions to all colleges are based on its results.

Many believe that the culture of capitation fees thrives because of a lucrative nexus between senior-level medical administrators and politicians. And it flourishes despite efforts by a section of the judiciary and legislature to thwart it, says Srinath Reddy, president, Public Health Foundation of India (PHFI), an organisation that works in the health sector.

In 2009, the health ministry introduced in Parliament the National Council for Human Resources for Health Bill, which noted: "Private medical colleges place a heavy burden of fees on students and their admission procedures are not transparent."

But the bill hasn't seen the light of day, rues Reddy. "Many MPs, who're close to medical college trustees, ensured the bill was buried," he says.

Chennai-based cardiac surgeon K. Shyamprasad, former vice-president, National Board of Examinations, goes a step further. "The nexus among politicians, bureaucrats and owners of private medical colleges is so powerful that it is capable of swaying even the judiciary," says Shyamprasad, a crusader against malpractices in healthcare.

In August 2014, a Supreme Court bench consisting of Justices F.M.I. Kalifulla and Shiva Kirti Singh observed that the menace of capitation fee was still prevalent in many private medical and engineering colleges. It appointed lawyer and former minister Salman Khurshid as amicus curiae to suggest measures to end the malpractice.

Many believe that a common test for private and government colleges could work towards regulating the admission process. But in July 2013, a Supreme Court division bench headed by the then Chief Justice, Altamas Kabir, struck down a demand for a single national-level entrance examination.

What worries health sector activists is the long-term impact of selling medical education to the highest bidder. "A low quality medical education system leads to poor quality healthcare delivery systems," warns Mihir Banerjee, vice-president, People for Better Treatment, a Calcutta-based healthcare NGO.

Rakhal Gaitonde of the Centre for Public Health and Equity, Bangalore, agrees. "Students from private medical colleges have little clinical skills because these colleges are not attached to credible hospitals," he explains.

The doctors' priority, he finds, is to reap profits on the investment they've made in the great medical education bazaar. And then money has to be collected for further studies.

Additional reporting by T.V. Jayan in New Delhi and Prasun Chaudhuri in Calcutta