Ayushman Bharat Fraud: National Health Authority slaps Rs 114 crore penalty on 2,842 hospitals
New Delhi: 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.
The report stateed that the action was taken by the NHA's National Anti-Fraud Unit (NAFU) as part of its efforts to curb misuse of the flagship health insurance scheme. Besides financial penalties, 2,003 hospitals were de-empanelled, while 839 hospitals were suspended. The authority also blocked Rs 678.47 crore worth of suspicious claims before they could be paid.
According to the report, the Ayushman Bharat scheme currently has a network of 35,908 empanelled hospitals across the country. Since its launch in 2018, the scheme has authorised nearly 11.93 crore hospital admissions worth Rs 1.78 lakh crore. During 2025-26 alone, 3.26 crore new Ayushman cards were issued and Rs 48,828 crore was spent on patient treatment.
The NHA has strengthened its fraud detection mechanisms by introducing AI-enabled and technology-driven screening systems. These include an auto-adjudication engine that identifies anomalies such as gender-package mismatches, repeat claims for procedures meant to be performed only once, and rapid verification of newly issued Ayushman cards using risk-based parameters.
The authority has also introduced a Hospital Vulnerability Index Dashboard to identify hospitals at higher risk of fraudulent activity. Additionally, biometric authentication has been made mandatory for every dialysis cycle under PM-JAY to prevent repeated or fabricated claims.
According to Medical Buyer, the NHA's fraud detection system currently uses more than 100 continuously refined algorithms capable of identifying unusual claim patterns, including medically impossible scenarios and suspicious billing practices before payments are authorised.
However, public health experts have pointed out that while stricter fraud detection is essential, timely reimbursement to compliant hospitals remains equally important to ensure uninterrupted healthcare services for PM-JAY beneficiaries. They have also called for greater transparency in the appeals process for hospitals facing suspension or de-empanelment.
