2,359 Hospitals de-empanelled, 1,200 suspended for AB PMJAY violations: JP Nadda

New Delhi: As many as 2,359 hospitals have been de-empanelled and more than 1,200 suspended by states and Union Territories for violating guidelines under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the Centre informed the Lok Sabha on Friday.

Union Health Minister JP Nadda said that 29 FIRs have also been registered and penalties amounting to Rs 328.49 crore have been imposed against hospitals and institutions found to have violated the scheme’s guidelines.

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The government has adopted a zero-tolerance approach towards fraud under AB-PMJAY, with the National Anti-Fraud Unit of the National Health Authority (NHA) using Artificial Intelligence (AI) and Machine Learning (ML)-based automated systems to identify suspicious claims.

According to Nadda, the automated mechanisms can flag unusual claim patterns, including unauthorised billing, duplicate entries, inflated procedures and misuse of patient identities, within 24 hours of a claim being submitted, reports The Daily.

Medical Dialogues had previously reported that the National Health Authority (NHA) has penalised 2,842 hospitals under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY) for fraudulent practices during the financial year 2025-26, imposing penalties amounting to Rs 114.06 crore, according to the NHA's Annual Report 2025-26. 

Claims identified as suspicious are subjected to further scrutiny before payments are released. Those found to be fraudulent are rejected, resulting in savings of Rs 676.14 crore as of July 31, 2026, Nadda added.

Apart from suspending and de-empanelling hospitals, authorities can impose financial penalties and register FIRs against institutions found violating the scheme's guidelines.

AB-PMJAY is the Centre's flagship health assurance programme and provides cashless coverage of up to Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to the bottom 40 per cent of India's population.

The scheme is being implemented across all states and Union Territories, with several states integrating it with their own health insurance programmes.

During the 2025-26 financial year, 3.75 crore Ayushman cards were issued to eligible beneficiaries, while 2.74 crore hospital admissions were authorised. A total of 5,074 hospitals were empanelled under the scheme during the year, according to the minister.

The Centre released Rs 8,438.27 crore to states and Union Territories during the financial year for implementation of AB-PMJAY.

Nadda said the release of funds is demand-driven and depends on utilisation certificates as well as the requirements projected by states and Union Territories.

Responding to another question, the minister said that 95.99 crore Ayushman Bharat Health Accounts (ABHA) had been created across the country as of July 31, 2026, including 5.25 crore in Gujarat. ABHA, a key component of the Ayushman Bharat Digital Mission (ABDM), is a unique 14-digit health identifier that enables citizens to securely access and manage their digital health records across the healthcare ecosystem, he said, reports TNIE.

The minister clarified that parliamentary constituency-wise data on the creation of ABHA accounts is not maintained.

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