Hospitals fined for fake Ayushman Bharat claims 

144 institutions were de-empanelled

April 10, 2022 02:25 pm | Updated April 11, 2022 01:24 am IST - NEW DELHI

144 hospitals were de-empanelled from the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana based on confirmed fraudulent behavior.

144 hospitals were de-empanelled from the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana based on confirmed fraudulent behavior. | Photo Credit: The Hindu Photo Library

Non-genuine 18,606 hospital transactions were detected in the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) with penalty amounting to ₹ 29.72 crore being levied on erring hospitals. Also 144 hospitals were de-empanelled from the scheme based on confirmed fraudulent behavior, said the Health Ministry in its reply to the Parliament in the recently concluded session.

The Ministry added that the National Health Authority (NHA)—the implementing agency of AB-PMJAY—had issued a comprehensive set of anti-fraud guidelines. The anti-fraud advisories were issued to States/UTs. National Anti-Fraud Unit (NAFU) was created at the NHA for overall monitoring and implementation of anti-fraud framework supported by State Anti-Fraud Units at the State level.

The Ministry further said that all claims required mandatory supporting documents alongwith on-bed patient photo before approval and payment. 

The feature of Aadhar-based biometric verification of beneficiary at the time of admission and discharge was launched at all private hospitals. 

``Use of artificial intelligence and machine learning is made for a comprehensive fraud analytics solution to detect fraud proactively, develop algorithms that can be used on large volumes of data to identify suspect transactions and entities and risk scoring of hospitals and claims,’’ said the Ministry. 

It added that a suitable penal action in terms of anti-fraud guidelines was taken against hospitals that were found involved in fraud. The AB-PMJAY was governed on a zero-tolerance approach to any kind of fraud viz. suspect/non-genuine medical treatment claims, impersonation and up-coding of treatment packages/procedures etc, said the Ministry.

Top News Today

Sign in to unlock member-only benefits!
  • Access 10 free stories every month
  • Save stories to read later
  • Access to comment on every story
  • Sign-up/manage your newsletter subscriptions with a single click
  • Get notified by email for early access to discounts & offers on our products
Sign in


Comments have to be in English, and in full sentences. They cannot be abusive or personal. Please abide by our community guidelines for posting your comments.

We have migrated to a new commenting platform. If you are already a registered user of The Hindu and logged in, you may continue to engage with our articles. If you do not have an account please register and login to post comments. Users can access their older comments by logging into their accounts on Vuukle.