Ayushman Bharat Targets Healthcare Fraud with Tough New Enforcement
In its strongest anti-fraud move yet, the Indian government has taken unprecedented action against misuse of the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the country’s flagship health insurance scheme. As part of a sweeping crackdown, authorities have de-empanelled 1,114 hospitals, suspended 549, and slapped INR 122 crore in penalties on 1,504 errant institutions, the Lok Sabha was told on Friday.
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A Zero-Tolerance Policy Meets Real Action
The Health Ministry’s response comes as part of a zero-tolerance stance against misuse of public healthcare benefits. The National Anti-Fraud Unit (NAFU), supported by state-level counterparts (SAFUs), has rolled out measures across the country to detect, deter, and disrupt fraudulent activity in real time. These include sophisticated AI tools, data analytics, random audits, and transparency protocols.
According to the minister, hospitals found violating empanelment terms, including denying care to eligible beneficiaries, now face strict repercussions. The scheme offers an INR 5 lakh annual health cover per family, making the integrity of its delivery system critical.
Ensuring Accountability and Protecting Beneficiaries
To safeguard citizens, a three-tier grievance redressal mechanism operates across district, state, and national levels. Complaints can be lodged via web portals, call centres (14555), email, or direct communication with State Health Agencies (SHAs). Steps are also in place to fast-track claims within 15 days for local hospitals, and 30 days for inter-state treatment.
This crackdown responds not only to financial irregularities but also to growing public outcry over ghost billing, unnecessary treatments, and misuse of the Ayushman card, issues that threaten trust in the system and its capacity to serve India’s poorest households.