Over 300 hospitals get show-cause notices for submitting forged claims under Ayushman Bharat scheme

Elaborating the actions taken by the Centre to prevent abuse of the scheme in hospitals, Choubey said a vigil is being maintained on utilisation of data through real time dashboards to identify suspect cases for over utilisation.

Suspect cases and entities are flagged based on different fraud control triggers and results are shared with state agencies for further investigation. Besides, regular joint medical audits along with state anti-fraud units (SAFU) of hospitals, both random and purposive, are conducted to identify any wrongdoing, he said.

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All admissions under the AB-PMJAY require pre-authorisations from respective state health agencies and a comprehensive set of anti-fraud guidelines have been issued from the time of launch of the scheme, the minister said.

Regular anti-fraud advisory notes are issued to all states advising them on measures to be adopted to prevent, detect and deter fraud, he said.

Packages prone to fraud and abuse are reserved for public hospitals or need mandatory pre-authorization and require detailed documentation before claims are paid.

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