Over 1,100 Hospitals May Face Removal from Ayushman Bharat Scheme Over Fraud

Nearly 600 hospitals across India are at risk of suspension, and over 1,100 could be delisted from the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) due to alleged fraudulent activities, according to the National Health Authority’s (NHA) anti-fraud unit. The unit has proposed penalties totaling ₹122 crore against 1,504 hospitals found violating scheme guidelines.

A recent report by the Parliamentary Standing Committee on Health and Family Welfare, tabled in Parliament on March 12, highlighted the misuse of funds by certain hospitals under the AB-PMJAY scheme. The committee expressed serious concern over how some hospitals allegedly exploit the scheme for financial gain and called for stricter oversight.

AB-PMJAY provides annual health coverage of ₹5 lakh per family for secondary and tertiary care to around 12.37 crore economically disadvantaged families. Currently, over 30,000 hospitals are empaneled under the scheme.

To prevent further misuse, the committee recommended that the NHA implement a data-driven fraud detection system, analyzing claims and hospital activities to identify irregularities. It also urged the adoption of artificial intelligence (AI) and digital tools for faster detection and intervention.

The Department of Health and Family Welfare has reaffirmed its zero-tolerance policy toward fraud and stressed that measures are being taken to strengthen monitoring and accountability. The committee further suggested developing 155 key performance indicators (KPIs) to track the effectiveness of fraud detection efforts.

The recommendations aim to protect the scheme’s integrity and ensure that benefits reach the intended beneficiaries without compromise.