New Delhi: The National Health Authority (NHA) has taken strict action against 2,842 hospitals for fraudulent practices under the government's flagship public health insurance scheme, imposing a penalty of ₹114.06 crore.
The penal action was taken during the last financial year as part of the National Anti-Fraud Unit's (NAFU) constant enforcement efforts under the National Health Authority. NAFU identified suspicious insurance claims under Ayushman Bharat and prevented the release of ₹678.47 crore, according to two officials and a document reviewed by Mint.
The authority de-empanelled 2,003 hospitals, suspended 839 facilities, and imposed penalties of ₹114.06 crore on non-compliant providers.
According to the NHA's annual report for 2025-26, the authority has deployed an auto-adjudication engine (AAE) along with system-generated validation alerts at the pre-authorisation stage to curb misuse. These systems automatically check for mismatches between patient gender and medical packages, detect repeat claims for once-in-a-lifetime procedures, and review all newly issued cards within 24 hours of generation using risk parameters.
“This massive anti-fraud drive is part of an all-inclusive framework aimed at safeguarding public funds. The NHA has operationalized a data-driven 'Hospital Vulnerability Index Dashboard' to detect high-risk and potentially fraudulent entities early,” the first of the two officials cited earlier said, both speaking on condition of anonymity.
Further, special safeguards have been deployed for specific treatments - for instance, biometric authentication of patients has been made mandatory at each individual cycle of dialysis packages to mitigate fake claim entries, the official added.
Queries sent to the health ministry spokesperson remained unanswered.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is a flagship central government scheme launched in 2018 that provides a cashless health cover of up to ₹500,000 per family per year for secondary and tertiary hospitalizations to eligible families. The scheme's nationwide network currently comprises a network of 35,908 hospitals, including 19,472 public and 16,436 private facilities.