Fraudulent claims have emerged as a major concern under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), with hospitals inflating insurance claims and misusing the scheme. According to the Union Health Ministry, three states—Haryana, Punjab, and Himachal Pradesh—account for over 13% of the fake claims detected nationwide, raising serious accountability issues.
Fraudulent Claims Worth ₹562.4 Crore Detected
The National Anti-Fraud Unit (NAFU), which monitors fraudulent activities under AB-PMJAY, revealed that out of 6.66 crore claims, around 2.7 lakh claims from private hospitals—worth ₹562.4 crore—were found to be inadmissible due to abuse, misuse, or incorrect entries.
Among the states, Haryana recorded the highest fraudulent claims, followed by Punjab and Himachal Pradesh.
- Haryana: ₹45.03 crore in false claims
- Punjab: ₹28.7 crore in fraudulent claims
- Himachal Pradesh: ₹75.65 lakh in fake claims
The data was shared by the Union Health Ministry in the Rajya Sabha in response to a query by MP A.D. Singh regarding fake billing under the scheme.
Fake Beneficiary Registrations Also Detected
Apart from fraudulent hospital claims, irregularities were also found in beneficiary registrations. In response to another query by MPs Javed Ali Khan and Ramji Lal Suman, the health ministry revealed that multiple beneficiaries were registered under a single mobile number, raising concerns about the misuse of the scheme.
- Punjab: 30,001 cases of duplicate registrations
- Haryana: 13,555 such cases
- Himachal Pradesh: 2,892 cases
Government’s Strict Action Against Fraud
The National Health Authority (NHA) has implemented several measures to prevent, detect, and penalize fraud under AB-PMJAY. The National Anti-Fraud Unit (NAFU) is working with State Anti-Fraud Units (SAFUs) to investigate fraudulent activities and take action.
To curb malpractice, the government has taken the following strict actions:
- 1,114 hospitals have been de-empanelled for fraud
- 549 hospitals have been suspended
- Hospitals involved in malpractice face blacklisting, de-empanelment, and penalties
- AI-based fraud detection systems and random audits have been introduced
To enhance fraud detection, advanced technologies like machine learning algorithms, image classification, fuzzy logic, and de-duplication techniques are being used. Additionally, real-time monitoring dashboards and data analytics tools have been deployed to track suspicious activities.
Scheme Expanded to Cover Senior Citizens
Despite these challenges, the government is expanding the benefits of AB-PMJAY. Recently, the scheme was extended to cover senior citizens aged 70 years and above, regardless of their socio-economic status, under AB-PMJAY with the Vay Vandana Card.
Under this flagship scheme, the government provides health coverage of ₹5 lakh per family per year for secondary and tertiary care hospitalizations.
The Union Health Ministry has reiterated that AB-PMJAY follows a zero-tolerance policy against fraud and will continue implementing strict measures to ensure the scheme reaches deserving beneficiaries without misuse.
