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In a significant move to curb fraud under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Indian government has de-empanelled 1,114 hospitals and penalised 1,504 others with a total fine of Rs 122 crore. Additionally, 549 hospitals have been suspended as part of a stringent crackdown on fraudulent practices reported by various States and Union Territories, the Lok Sabha was informed on Friday.
Minister of State for Health and Family Welfare Prataprao Jadhav emphasized that the AB-PMJAY operates on a zero-tolerance policy against misuse and abuse of the scheme. To implement this, a robust anti-fraud mechanism has been established, including the National Anti-Fraud Unit (NAFU), dedicated to preventing, detecting, and deterring fraudulent activities within the scheme.
Hospitals found involved in irregularities face strict actions such as suspension or de-empanelment. Importantly, empanelled hospitals are mandated not to deny treatment to eligible beneficiaries. In case of denial, beneficiaries can lodge complaints through a three-tier grievance redressal system operating at district, state, and national levels. Various complaint channels are available, including an online portal, CGRMS, call centers (14555), email, and letters to State Health Agencies. Based on complaints, appropriate measures, including helping beneficiaries access treatment, are taken promptly.
The scheme also enforces timely settlement of claims, with guidelines mandating payments within 15 days for intra-state hospitals and within 30 days for portability claims involving hospitals outside the beneficiary’s home state. The minister highlighted continuous improvements in the average turnaround time for claim settlements through regular reviews and capacity-building initiatives.
This clampdown is part of the government’s ongoing efforts to maintain the integrity of the Ayushman Bharat scheme while ensuring quality healthcare services reach the underserved population.
Disclaimer: This article is based on official information provided by the Ministry of Health and Family Welfare and reports from multiple news sources as of August 2025. The situation may evolve as the government continues efforts against healthcare fraud under the Ayushman Bharat scheme.
