Fraud under AB-PMJAY- 210 hospitals de-empanelled, 188 suspended by SHAs: Mandaviya

New Delhi: Union Health Minister Mansukh Mandaviya said on Friday that the National Health Authority (NHA) has set up a National Anti-Fraud Unit (NAFU), which has been entrusted with the responsibility of preventing and detecting fraud and abuse under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

The minister said this in the LoK Sabha in response to a question as to whether the government has constituted any ‘Anti-Fraud Unit’ to deal with ‘fraudulent’ transactions under the AB-PMJAY .

The anti-fraud structure has NAFU at the Central level, followed by State Anti-Fraud Units (SAFUs) at the state level, he said.

“NHA uses artificial intelligence (AI) and machine learning (ML) technologies to detect suspicious transactions / potential frauds under AB-PMJAY. These technologies are used for prevention, detection and deterrence of healthcare frauds in the scheme implementation and are helpful in ensuring appropriate treatment to the eligible beneficiaries,” Mandaviya said.

The Minister added, “As on August 5, appropriate actions against over 1.6 lakh claims worth Rs 278 crore were taken by State Health Agencies (SHA) as per guidelines issued by the NHA. A total of 210 hospitals have been de-empanelled and 188 hospitals have been suspended due to their involvement in activities non-compliant with the guidelines issued by NHA or SHA. A penalty of Rs 20.71 crore has been levied against which an amount of Rs 9.5 crore has been recovered.”

Launched on September 23, 2018, the AB-PMJAY provides a health cover up to Rs five lakh per family per year, for secondary and tertiary care hospitalisation services.

It may be mentioned that a report of the Comptroller and Auditor General of India (CAG) which was presented in the Parliament earlier this week, has highlighted various irregularities in the implementation of the AB-PMJAY. (IANS)

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