**Executive Summary**
This document is a response to Lok Sabha Unstarred Question No. 2241 regarding fraudulent activities related to Ayushman Bharat Cards, to be answered on December 12, 2025. The response details measures taken by the Government to address fraud, enhance transparency, and strengthen grievance redressal within the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme. Key actions include establishing anti-fraud units, automated triggers, and a multi-tiered grievance redressal system.
**Key Points / Main Content**
* **Fraud Prevention and Detection:**
* AB-PMJAY operates with a zero-tolerance approach to fraud.
* The National Anti-Fraud Unit (NAFU) uses AI/ML-based automated triggers in the Transaction Management System (TMS) to flag suspicious claims.
* Flagged cases are routed to State Health Authorities (SHAs) for verification.
* Regular capacity-building workshops and field-level training sessions are conducted.
* **Action Against Fraudulent Entities:**
* Actions taken include suspension, show cause notices, warning letters, de-empanelment of hospitals, de-activation of e-cards, penalties, and lodging of FIRs.
* As of 15.11.2025, 1184 hospitals were de-empanelled, penalties of Rs. 231.88 crore were levied, and 411 hospitals were suspended.
* **Card Creation and Validation:**
* The card creation process includes multiple validations, such as de-duplication, Aadhaar verification (name, gender, date of birth), and eKYC validation.
* **Grievance Redressal:**
* Beneficiaries can register grievances via the Centralized Grievance Redressal Management System (CGRMS) or 24x7 helpline (14555).
* A three-tier grievance redressal system exists at the District, State, and National levels, with dedicated nodal officers and Grievance Redressal Committees.
**Impact Analysis**
**Hospitals and Healthcare Providers**
* **Impact:** Subject to scrutiny for fraudulent activities, potential de-empanelment, penalties, and legal action.
* **Action Required:** Ensure compliance with AB-PMJAY guidelines, avoid fraudulent practices, and cooperate with investigations.
**Beneficiaries (Ayushman Bharat Card Holders)**
* **Impact:** Enhanced card validation and a more robust grievance redressal system to address issues.
* **Action Required:** Utilize available grievance redressal mechanisms (CGRMS, helpline) to report issues.
**State Health Authorities (SHAs)**
* **Impact:** Responsibility for verifying suspicious cases flagged by automated triggers.
* **Action Required:** Investigate flagged cases, take appropriate action against fraudulent entities, and participate in capacity-building exercises.
Key Entities Referenced
Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): A health insurance scheme aimed at providing financial risk protection to vulnerable families for secondary and tertiary care hospitalization.
National Health Authority (NHA): The apex body responsible for implementing AB-PMJAY and other related health programs.
National Anti-Fraud Unit (NAFU): Established at the NHA, it's responsible for preventing and detecting fraud within the AB-PMJAY scheme.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 2241
TOBE ANSWERED ON12TH DECEMBER, 2025
FAKE REGISTRATIONIN AYUSHMAN BHARATCARD
†2241.SMT.GENIBEN NAGAJI THAKOR:
Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:
(a) whether it is a fact that complaints regarding Fraudulent activities like fake registration
and fake claims in the name of Ayushman Bharat Cards, misuse of the card and irregularities
intreatmentbills have beenreceivedfrom variousStatesinthe country;
(b) if so, the details thereof, State-wise especially Gujarat along with the number of such
cases registered during the last three years;
(c) the steps taken by the Government to investigate such irregularities along with the action
takenagainst the culprits; and
(d) whether the Government propose to make the Ayushman Card System more transparent,
strengthen the verification process and make the grievance redressal mechanism more
effective, if so, the detailsthereof?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND
FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a)to (c):AyushmanBharat-PradhanMantriJanArogyaYojana(AB-PMJAY)isgovernedon
a zero-tolerance approach towards fraud. National Anti-Fraud Unit (NAFU) established at
National Health Authority (NHA), uses AI/ML-based automated triggers within the
Transaction Management System (TMS) to automatically flag unusual claim patterns such as
duplicateentries,inflatedprocedures,ormisuseofpatient’sidentity.Regularcapacity-building
workshops and field-level training sessions are conducted to strengthen the overall anti-fraud
frameworkofAB-PMJAY.NAFUworksinclosecoordinationwiththeStateAnti-FraudUnits
(SAFU) to investigate and take action on cases of fraud. Cases flagged as suspicious by the
automatedtriggersareroutedtotherespectiveStateHealthAuthorities(SHAs)forverification.
Appropriate action including suspension, issue of show cause notices, warning letter, de-empanelment of hospitals, de-activation of e-cards, levying penalty on errant hospitals and
lodging of FIRs, are taken against fraudulent entities. 1184 hospitals were de-empanelled,
penalties amounting to Rs. 231.88 crore has been levied against fraudulent entities and 411
hospitalsweresuspendedbytheStates/UTs,ason15.11.2025.
(d): Card creation process under AB-PMJAY includes multiple validations such as de-
duplication, correctness of Aadhaar, name, gender and date of birth. Ayushman Card is
generatedonlyaftersuccessful validationof eKYC datareceivedfrom Aadhaar.Beneficiaries
mayregister theirgrievancesusing the CentralizedGrievance Redressal Management System
(CGRMS) or 24x7helpline (14555). Athree-tier grievanceredressal system at District, State,
and National level has been established to resolve the issues faced by beneficiaries. At each
level, there is a dedicated nodal officer and Grievance Redressal Committees to address the
grievances.
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