Govt Acted Against 1.6 Lakh Fraud Claims Worth INR 287 Cr Under AB-PMJAY Till Aug 5: Health Minister Mandaviya     

Under the AB-PMJAY, it was revealed that patients who were dead in the data continued to grant treatment. Many fraud cases are reported in Chhattisgarh, Haryana, Jharkhand, Kerala, and Madhya Pradesh. The government has started using AI and ML technologies to tackle these frauds.'¯ '¯ 

In a significant development, the government of India has acted against 1.6 Lakh fraud claims till Aug 5, accounting to INR 287 Cr under the AB-PMJAY scheme, informed Health Minister, Mansukh Mandaviya in the Lok Sabha.  

The Minister also informed that 210 hospitals have been de-empaneled, and 180 hospitals are suspended. This action has been taken because of their participation in activities that are against the guidelines of the National Health Authority (NHA).

The NHA has set up a National Anti-Fraud Unit (NAFU) with the primary responsibility of prevention, detection and deterrence of fraud and abuse under AB-PMJAY, said Mansukh Mandaviya, the Union Health Minister. 

Under the NAFU scheme, the anti-fraud structure has been launched at the central level, including state anti-fraud units. 

NHA uses Artificial Intelligence (AI) and Machine Learning (ML) technologies to detect suspicious transactions or potential frauds under the AB-PMJAY, said Mandaviya. 

The technologies used by NHA are mainly for prevention, detection and deterrence of healthcare frauds. It helps to ensure that the eligible beneficiaries receive the proper care. 

The government of India launched AB-PMJAY on Sept 23, 2018. The objective of this program is to provide healthcare coverage of INR 5 Lakh per family every year. The facilities will be given to poor and vulnerable families in secondary and tertiary care hospitals. 

'œThe government of India launched the Ayushman Bharat Digital Mission (ABDM) to provide a platform that enables interoperability of health data within the health ecosystem to create a longitudinal Electronic Health Record (EHR) for every citizen', said Mandaviya. 

ABDM consists of some important registries such as, 

• Ayushman Bharat Health Account (ABHA) 
• Healthcare Professional Registry (HPR) 
• Health Facility Registry (HFR) 
• Drug Registry  

As mentioned by the health ministry, a total of 44,19,86,761 ABHAs were generated, and 2,15,250 healthcare facilities registered on HFR as of Aug 8, 2023.  

Furthermore, 29,28,29,789 health records have been linked with ABHA, and 2,13,784 healthcare professionals have been registered on HPR. 

Ayushman Bharat Digital Mission (ABDM) was launched in 2021. The program's primary goal is to build the foundation to support the nation's integrated digital health system. It will eliminate the gap between different stakeholders of the healthcare ecosystem.  

It is an open-API ecosystem and can share data easily per the NDHB standards. The design and development of the APIs will incorporate security and privacy considerations, which should be reviewed before implementation. 

The Digital Health Incentive Scheme (DHIS), under ABDM, receives an extension by NHA till December 31, 2023. After implementing this scheme, the hospitals and diagnostic labs will get incentives.  

During the ABDM program, different digital healthcare applications were launched to collect the correct data of the patients, such as CoWIN and Aarogya Setu.