In what is being called one of the biggest scams to hit India’s flagship health initiative, over ₹10 crore was fraudulently siphoned off from the Ayushman Bharat scheme in Uttar Pradesh. Over 6,200 fake beneficiary names and 39 hospitals are under investigation, as authorities uncover a sophisticated fraud that exploited official logins and digital payment systems.
Fake Patients, Real Payments: How Hospitals Pocketed Crores via Ayushman Bharat
The Ayushman Bharat scheme, India’s ambitious health insurance program for the underprivileged, is under a cloud after a sensational ₹9.94 crore scam was unearthed in Uttar Pradesh. The fraud, which took place between May 1 and May 22, 2025, involved fake reimbursements for 6,239 fictitious patients from 39 hospitals. Investigators say the payments were routed through forged credentials on the official National Health Authority (NHA) portal.
The exposure came to light when Dr. Brijesh Kumar Srivastava, the nodal officer of the agency “SACHIIZ,” which oversees claim settlements under the scheme, lodged an FIR at the Hazratganj police station in Lucknow. The report alleges unauthorised use of email IDs belonging to senior agency officials, including the OSD, Manager, and Accounts Officer, to clear bogus payments.
The money didn’t come from the agency. It was siphoned by manipulating the internal systems. FIRs have been filed, and investigations are ongoing. Several individuals are under the scanner, as stated by Inspector Vikram Singh.
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The Modus Operandi: Exploiting the System from Within
Ayushman Bharat, launched in 2018, aims to provide health insurance of up to ₹5 lakh per family per year for secondary and tertiary care hospitalization. Hospitals claim reimbursements by uploading bills to the NHA portal, which are verified and sanctioned digitally by designated officials.
This very process became the weapon of fraud. According to initial findings:
- The scammers infiltrated the login credentials of key officials — including the CEO, Finance Manager, and Accounts Officer — bypassing the multi-layered checks.
- Fake entries of treatments and surgeries were uploaded against fabricated patient records.
- Payments were then authorized using tampered email IDs and credentials, followed by direct bank transfers to select hospitals.
The agency’s office, located in the Navchetna Kendra on Ashok Marg, is now being treated as the focal point of a deeper cybersecurity breach.
Authorities suspect the involvement of an internal-external nexus, rogue IT personnel with knowledge of backend operations colluding with select hospitals. The cyber cell is now examining digital footprints, system logs, and email trails to trace the source of the breach.
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Scheme in Question: Trust Undermined, System Exploited
This is not the first time the Ayushman Bharat scheme has come under scrutiny, but the scale and speed of this fraud have stunned both the public and policymakers. Designed to ensure that India’s poorest citizens have access to quality medical treatment without financial strain, the scheme is now facing trust issues.
Health economists warn of larger implications and state that this kind of breach erodes credibility, both among beneficiaries and service providers. It defeats the very purpose of universal health coverage. The Ministry of Health has ordered an immediate statewide audit of Ayushman Bharat transactions post-April 2025. There are concerns that the scam may not be isolated to just one region.
Meanwhile, officials have assured swift action. The Uttar Pradesh Police is working with cybersecurity experts and the National Health Authority to identify all individuals and institutions involved. Multiple arrests are expected soon, officials confirmed.
About the author – Prakriti Jha is a student at National Forensic Sciences University, Gandhinagar, currently pursuing B.Sc. LL.B (Hons.) with a keen interest in the intersection of law and data science. She is passionate about exploring how legal frameworks adapt to the evolving challenges of technology and justice.