The Ayushman Bharat Scheme-world’s biggest healthcare scheme aimed at providing free healthcare to millions of underprivileged families in India, has come under scrutiny after reports revealed widespread misuse by private hospitals.
According to data from the National Anti-Fraud Unit (NAFU), 2.7 lakh claims out of 6.66 crore processed were found to be fake or incorrect. As per the information these fraudulent claims amount to Rs 562.4 crore.
The fraudulent practices include fake billing, incorrect entries, and misuse of the scheme, which has diverted crucial funds meant for genuine patients. Uttar Pradesh reported the highest amount of fake claims, totaling Rs 139 crore, followed by other states like Chhattisgarh, Haryana, Kerala, and Bihar.
Claims flagged as suspicious by NAFU are put on hold until they are thoroughly checked by the State Anti-Fraud Unit (SAFU). This process includes need based field verifications and Any hospital found guilty faces strict action to protect the integrity of the scheme.
This information was revealed in a written reply by Minister of State for Health and Family Welfare Prataprao Jadhav in the Rajya Sabha. He emphasized that the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) follows a “zero-tolerance policy” towards fraud. The National Anti-Fraud Unit (NAFU) works closely with state teams to prevent, detect, and act against fraudulent activities.
The minister claimed that the strict action has been taken, with 1,114 hospitals have been de-empanelled, and 549 hospitals have been suspended under AB-PMJAY.
The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a flagship scheme of the Government which provides health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to approximately 55 crore beneficiaries corresponding to 12.37 crore families constituting economically vulnerable bottom 40% of India’s population.
Recently, the scheme has been expanded to cover 6 crore senior citizens of age 70 years and above belonging to 4.5 crore families irrespective of their socio-economic status under ABPMJAY with Vay Vandana Card.
However, the exploitation by private hospitals through fake billing has cast a shadow over its integrity.
This malpractice not only undermines the scheme’s objectives but also diverts crucial funds meant for genuine healthcare needs. In his reply the minister assured the house that the AB-PMJAY is governed on a zero-tolerance approach towards any kind of fraud and abuse and various steps are taken for prevention, detection and deterrence of different kinds of fraud that could occur in the scheme at different stages of its implementation.
