Rs 1.21 lakh Crore claims pending under Ayushman Bharat, reveals RTI

New Delhi: A total outstanding amount of Rs 1,21,61,45,63,617 (₹1.21 lakh crore) remains unpaid to empanelled hospitals under the Ayushman Bharat scheme (AB-PMJAY), with more than 63 lakh pending claims yet to be cleared, revealed the data shared by the National Health Authority (NHA) in response to a Right to Information (RTI) application. 

The RTI query, filed by Mr. Ajay Basudev Bose, sought details regarding the statistical details of the total pending amount owed to hospitals empanelled under the Ayushman Bharat Yojana scheme. 

In response to the RTI, the NHA disclosed that a total of 63,89,517 claims remain uncleared, and these pending claims led to a staggering amount of Rs 1,21,61,45,63,617 (Rs 1.21 lakh crore) remaining as outstanding dues to empanelled hospitals, leaving these hospitals in financial distress.

Also read- Rs 1500 core pending for hospitals under Ayushman Bharat, IMA Raipur raises concern

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a health insurance scheme providing financial protection for secondary and tertiary healthcare to economically vulnerable families. Beneficiaries can access cashless treatment at empaneled hospitals, ensuring affordable healthcare services and reducing out-of-pocket medical expenses.

However, the large number of unpaid claims and the huge outstanding amount indicate that these empanelled hospitals have not received their due payments for a long time, which remains a major concern for the healthcare sector as it could cause financial strain. 

The RTI response was highlighted by Dr Lakshya Mittal, National President of United Doctors Front (UDF) in his official 'X' handle who described the situation as a shameful burden and questioned the government's lack of response into the matter. 

In his recent post, Dr Mittal said, "RTI reveals that amounting to Rs 1.21 lakh crore pending under Ayushman Bharat. More than 63 lakh claims are pending, and hospitals are in crisis. Who will take responsibility for this? The government is silent Such a huge outstanding amount –Is this the health revolution? This burden is shameful."

Medical dialogues had previously reported that the Haryana unit of the Indian Medical Association (IMA) announced that around 600 private hospitals across the state will cease providing services under the Ayushman Bharat scheme from February 3. The decision was made following the government's failure to clear pending reimbursements totalling Rs 400 crore.

Meanwhile, recent data provided in the Rajya Sabha revealed that out of Rs 6.66 crore claims processed under the Ayushman Bharat-PM Jan Arogya Yojana (AB-PMJAY), nearly 2.7 lakh claims from private hospitals were found to be fraudulent. These claims, worth Rs 562.4 crore, involved alleged misuse, abuse, or incorrect entries. As a result, the government has de-empanelled 1,114 hospitals and suspended 549 hospitals under the scheme so far in this regard. 

Also read- Rs 562.4 crore fake claims under AB-PMJAY: 1,114 Hospitals de-empanelled, 549 suspended