23000 fraud transactions done by Hospitals under Ayushman Bharat: Health Ministry data

New Delhi: Responding to a series of questions raised regarding the number of fraudulent transactions recorded at empanelled hospitals under the AB-PMJAY in FY-2021-22, the Union Minister of State for Health and Family Welfare recently apprised the Parliament that 23000 fraudulent transactions were recorded at empanelled hospitals, the reasons for the high incidence of such transactions under the AB-PMJAY and the steps taken by the Government to rectify such transactions.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is governed on a zero-tolerance approach to any kind of fraud such as a suspect or non-genuine medical treatment claims, impersonation and up-coding of treatment packages and procedures etc, Minister of State for Health Bharati Pravin Pawar said in a written reply.

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Responding to a question on whether it is a fact that around 23,000 fraudulent transactions were recorded at empanelled hospitals under the AB-PMJAY in 2021-22, she said the National Health Authority - the implementing agency of AB-PMJAY has issued a comprehensive set of anti-fraud guidelines. Anti-fraud advisories are issued to states and Union territories.

National Anti-Fraud Unit is created at NHA for overall monitoring and implementation of an anti-fraud framework supported by state anti-fraud units at the state level. ''All claims require mandatory supporting documents along with on-bed patient photos before approval and payment. The feature of Aadhaar-based biometric verification of beneficiary at the time of admission and discharge is launched at all private hospitals. ''Use of artificial intelligence and machine learning is made for a comprehensive fraud analytics solution to detect fraud pro-actively, develop algorithms that can be used on a large volume of data to identify suspect transactions and entities and risk scoring of hospitals and claims,'' the minister added.

Providing details of action taken by state health agencies, the minister said Chhattisgarh accounts for the highest number of 6913 confirmed claims in which penal actions were taken for fraudulent hospital transactions under the AB-PMJAY followed by Madhya Pradesh, Punjab, Kerala and Jharkhand.

The other States which recorded cases of fraudulent transactions were Haryana (1349 cases), Uttar Pradesh (1211), Jammu & Kashmir (575), Uttarakhand (147), Gujarat (130), Meghalaya (93), Bihar (28), Assam (2), Himachal Pradesh (2), Mizoram (2).

While Puducherry and Tripura recorded the lowest cases with one each.

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