Lucknow | Special Correspondent: A large-scale fraud has been unearthed in Uttar Pradesh under the government’s flagship health insurance program — Pradhan Mantri Jan Arogya Yojana (Ayushman Bharat).
Preliminary findings by the State Agency for Comprehensive Health Insurance Scheme (SACHIS) indicate that nearly 400 fake Ayushman cards were issued, leading to the unauthorized admission of more than 250 patients across several hospitals.
All such approvals have now been revoked, and the cards declared invalid, officials confirmed.
Initial Scrutiny Uncovers Alarming Details
According to officials involved in the probe, a random verification of around 1,300 cards revealed that approximately one in every three was fake.
Hospitals had allegedly registered patients using these fraudulent cards and even submitted claims for reimbursement of treatment costs.
In several cases, records showed patients as “admitted,” though they had never actually visited the hospitals.
Sources within the health department said that the manipulation was made possible through lapses in the verification process and collusion between certain data entry operators and middlemen.
Agencies and Hospitals Under the Scanner
The investigation has brought to light major discrepancies in the card generation process.
Some enrollment agencies issued Ayushman cards without biometric authentication, while others allegedly used recycled or fabricated identities.
Officials said that SACHIS will now conduct a comprehensive audit of the agencies and hospitals linked to the irregularities.
“This appears to be a systematic manipulation rather than an isolated case. Accountability will be fixed at every level,”
said a senior SACHIS official.
Patients and Intermediaries Face Investigation
The probe is not limited to agencies and hospitals. Beneficiaries whose names were used to generate fake cards are also being investigated.
Authorities suspect that certain individuals knowingly lent their credentials in exchange for monetary benefits.
The fraud has prompted the government to rethink the verification architecture of the Ayushman Bharat database.
Reform Measures: Biometric and OTP Verification Made Mandatory
In response to the scam, the Uttar Pradesh government has implemented new measures to tighten digital verification.
From now on, no Ayushman card will be issued without biometric confirmation and mobile OTP validation.
Similarly, hospital admissions and discharges will require biometric authentication to prevent false reporting and inflated claims.
250 Admissions in Just 20 Days
According to the official report, over 250 fake admissions were recorded within just 20 days using these forged cards — highlighting the organized nature of the operation.
Investigators believe the fraud may extend beyond the initial sample and could involve multiple districts.
Government Orders Statewide Audit
Taking serious note of the findings, the state health department has ordered a statewide audit of Ayushman Bharat card issuance and claim approvals.
Hospitals found complicit in submitting fraudulent claims may face suspension and financial penalties.
A Blow to the Credibility of Digital Welfare Systems
Experts say the case underscores the vulnerabilities in India’s digital welfare infrastructure, despite ongoing efforts to modernize public health systems.
They emphasize that robust biometric authentication and transparent claim tracking are essential to ensure that public funds reach genuine beneficiaries.
