In response to Unstarred Question No. 1011 raised by Smt. Mala Roy on December 5, 2025, regarding fake claims under the Ayushman Bharat Scheme, the Minister of State in the Ministry of Health and Family Welfare (Shri Prataprao Jadhav) stated that the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) operates with a zero-tolerance approach towards fraud. Advanced AI/ML-based analytics are employed to monitor fraud transactions proactively. The government takes preventive, detective, and deterrent measures against various types of fraud during the scheme's implementation. A National Anti-Fraud Unit has been established at the National Health Authority, collaborating with State Anti-Fraud Units to investigate and address fraud-related issues. Actions against fraudulent entities include suspension, show cause notices, warning letters, de-empanelment of hospitals, de-activation of e-cards, penalties on errant hospitals, and lodging of FIRs.
Key Entities Referenced
Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): A scheme mentioned regarding data on fake claims and steps taken to prevent fraud.
Ministry of Health and Family Welfare: The primary ministry responsible for answering the question related to the Ayushman Bharat scheme.
National Anti-Fraud Unit: Established at National Health Authority to investigate and take action on fraud related to the scheme.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 1011
TOBE ANSWERED ON05TH DECEMBER, 2025
FAKECLAIMS UNDER AYUSHMAN BHARATSCHEME
1011. SMT.MALAROY:
Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:
(a) whether the Government has any data with regard tocases of fake claim under Ayushman
Bharat Mission inthe country;
(b) if so, the details of totalamount of such fraud cases during the last three years, State-wise
andyear-wise;and
(c)the steps takenbythe Government topreventsuch kindof fraudsinfuture?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND
FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a) to (c): Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is governed
on a zero-tolerance approach towards fraud. Advanced AI/ML-based analytics are used to
proactively monitor fraud transactions. Various steps are taken for prevention, detection and
deterrence of different kind of frauds that could occur in the scheme at different stages of its
implementation. National Anti-Fraud Unit has been established at National Health Authority
which works in close coordination with State Anti-Fraud Units to investigate and take action
onissues relatedtofraud.
Appropriate action like suspension, show cause notice, warning letter, de-empanelment of
hospitals, de-activation of e-cards, levying penalty on errant hospitals and lodging of FIRs,
are takenagainst fraudulent entities.
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