Ayushman Bharat Scheme Scammed: Private Hospitals Defraud Government, Endanger Public Health

New Delhi:Private hospitals across India are exploiting the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), a flagship government scheme designed to provide healthcare coverage of ₹5 lakh per family per year to economically vulnerable populations. In a disturbing trend, a large number of private healthcare providers are found to be involved in fraudulent activities, jeopardizing the health and well-being of millions of Indians and defrauding the government of billions in the process.

According to reports from the National Anti-Fraud Unit (NAFU), out of 6.66 crore claims processed under the scheme, approximately 2.7 lakh claims, amounting to ₹562.4 crore, were found to be non-admissible due to abuse, misuse, or incorrect entries. These fraudulent claims have raised serious concerns about the integrity of the scheme, which covers nearly 55 crore beneficiaries, including 6 crore senior citizens. This abuse not only drains public funds but also puts vulnerable populations at risk by diverting resources meant for their healthcare needs.

The NHA has been proactive in addressing these fraudulent activities. Suspected claims are withheld pending thorough scrutiny, and hospitals involved in fraudulent activities face deempanelment, suspension, or even blacklisting from the AB-PMJAY network. Penalties and legal actions are also being pursued against such hospitals. As a result of these measures, over 1,100 hospitals have been de-empanelled and more than 500 have been suspended for their involvement in fraudulent claims.

State-wise data reveals the widespread nature of this issue. In Uttar Pradesh alone, fraudulent claims amount to ₹13,902.94 lakh, while other states like Gujarat, Madhya Pradesh, and Bihar also report significant misuse. Gujarat saw ₹3,158.18 lakh in fraudulent claims, while Madhya Pradesh recorded ₹11,934.11 lakh. Even smaller regions like Puducherry and Dadra and Nagar Haveli are not immune, with claims totaling ₹22.79 lakh and ₹0.98 lakh, respectively.

The government has responded to this challenge by deploying advanced technologies, such as AI-based systems and machine learning algorithms, to detect fraud in near real-time. Additionally, the NHA conducts random audits, surprise inspections, and regular medical audits to ensure the authenticity of claims. These efforts have led to the identification and prevention of further misuse, but the scale of the problem remains concerning.

As the government continues its efforts to curb these fraudulent activities, the impact on public health is clear. The misuse of the AB-PMJAY scheme threatens to undermine its effectiveness, denying the most vulnerable citizens the healthcare they desperately need. With billions of rupees involved and the health of millions at stake, it is imperative that stricter measures be implemented to protect the scheme and ensure its success in providing affordable healthcare to those who need it most.