Health authorities in Uttar Pradesh’s Bijnor district have taken enforcement action against a cluster of empanelled hospitals under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, after a surprise inspection drive found that 16 of 20 hospitals checked had failed to comply with the scheme’s operational guidelines. Six hospitals have been served suspension notices with payments withheld, while ten others face notices demanding explanations, part of a broader enforcement push that has intensified across the state in recent months.
What the Inspections Found
The State Health Agency stepped up its probe after reports flagged suspected misuse of the scheme, prompting a special inspection team to conduct unannounced visits across the district. According to officials, the alleged violations centre on two recurring tactics: repeated admissions of members from the same family to generate multiple insurance claims, and unnecessary ICU admissions used specifically to inflate reimbursement amounts.
The ICU pattern is a well-documented vulnerability in the scheme’s design. Hospitals under AB-PMJAY receive substantially higher payments for ICU admissions compared with general ward care, an incentive structure that national officials have separately flagged, including cases where a single ICU patient’s photograph was reused across multiple claims with only the name and patient details altered to generate additional reimbursements.
Escalating Penalties and a Larger National Pattern
Officials said hospitals that fail to deposit previously imposed penalties will now face a tenfold increase in the amount owed, a sharp escalation meant to close a gap where non-compliant hospitals had reportedly treated earlier fines as a manageable cost of continuing questionable billing practices. Notices have also been issued to the audit agency responsible for reviewing these hospitals’ claims, alongside a demand for explanation from the district programme coordinator over the alleged oversight lapses.
The Bijnor action sits within a much larger enforcement effort unfolding nationally. The Union Health Ministry has confirmed that 1,184 hospitals have been de-empanelled for fraud under AB-PMJAY, with penalties exceeding ₹231 crore levied and 411 hospitals suspended across states and union territories. The National Anti-Fraud Unit has separately identified fraudulent claims worth ₹562.4 crore nationwide, with Chhattisgarh emerging as a particular hotspot after one 2026 sweep penalised 33 private hospitals in a single round for double-billing, ghost patients and unnecessary procedures, patterns closely mirroring what inspectors now allege in Bijnor.
What Comes Next
Officials in Bijnor said all empanelled hospitals must strictly adhere to the scheme’s Standard Treatment Guidelines and prescribed quality benchmarks, warning that any deviation affecting patient care or resulting in wrongful financial claims will attract strict regulatory action going forward.
The investigation remains ongoing, with authorities examining patient records, admission histories, treatment documentation and claim submissions to determine the full extent of the alleged misuse. Further action against the flagged hospitals is expected once this review is complete, officials said, with the outcome likely to shape how the state approaches empanelment audits in other districts.
