The government has de-empanelled 1,114 hospitals, fined 1,504 ₹122 crore, and suspended 549 for fraud under Ayushman Bharat. A strong anti-fraud system, grievance redressal mechanism, and stricter claims settlement timelines aim to protect beneficiaries and improve service delivery.
The government has taken strict action against fraudulent activities under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Parliament was informed on Friday. Minister of State for Health and Family Welfare Prataprao Jadhav told the Lok Sabha that a total of 1,114 hospitals had been de-empanelled, penalties amounting to ₹122 crore had been imposed on 1,504 hospitals, and another 549 hospitals had been suspended for irregular practices as reported by the states and Union Territories. The total empaneled hospitals are 31,987 (17,453 are public and 14,534 are private). He underlined that the scheme operates on a “zero-tolerance” approach to misuse, with a robust system in place to detect and deter fraud.
To strengthen oversight, a National Anti-Fraud Unit (NAFU) has been set up to monitor and address fraudulent practices under the scheme. The minister emphasized that hospitals empanelled under AB-PMJAY are not permitted to deny treatment to eligible beneficiaries. In cases where treatment is denied, beneficiaries are entitled to lodge complaints. A comprehensive three-tier grievance redressal mechanism—at the district, state, and national levels—has been established to resolve such issues. Dedicated nodal officers and grievance committees ensure complaints are addressed effectively, while beneficiaries may register grievances through multiple channels including a web portal, a centralized grievance redressal management system (CGRMS), call centres (14555), emails, or letters to state health agencies. Depending on the nature of the grievance, necessary action, including direct support to patients in availing treatment, is taken.
Jadhav also provided details about the settlement of claims under AB-PMJAY. The process of claim settlement is handled by respective State Health Agencies (SHAs), with strict timelines in place: claims from hospitals within the state must be settled within 15 days, while inter-state or portability claims must be settled within 30 days. The National Health Authority (NHA) has issued detailed guidelines to ensure timely settlements. Over the years, there has been a steady improvement in the overall average turnaround time for payments, reflecting greater efficiency in implementation. Regular review meetings and capacity-building initiatives are also conducted to improve the claims process and ensure that funds are channelled smoothly to service providers.
These measures, the minister said, are aimed at maintaining the integrity of the scheme, protecting beneficiaries from malpractice, and ensuring better delivery of healthcare services under India’s largest health insurance initiative.
