Parliament Question: Irregularities in AB-PMJAY

GOVERNMENT OF INDIA MINISTRY OFHEALTH AND FAMILYWELFARE DEPARTMENT OF HEALTH AND FAMILYWELFARE LOK SABHA STARRED QUESTION NO. *214 TO BE ANSWERED ON THE 13THFEBRUARY, 2026 IRREGULARITIES IN AB-PMJAY *214. SHRI LAVU SRI KRISHNA DEVARAYALU:

Will the MINISTER OF HEALTH AND FAMILY WELFARE be pleased to

state:

(a) whether the Government has received cases/complaints of irregularities or violations done by hospitals in Andhra Pradesh under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) scheme;

(b) if so, the details thereof alongwith the nature of such violations;

(c) the details of actions taken against such hospitals in the said State, specifically the total number of hospitals de-empanelled, suspended or penalised along with the amount of penalty levied, during the last five years, district-wise;

(d) the details of the specific methods and technologies employed by the National Anti-Fraud Unit (NAFU) to detect and prevent fraudulent activities under the scheme; and

(e) the details of the coordination mechanism adopted by NAFU with the State Anti-Fraud Units (SAFU) in terms of data sharing, investigation protocols and real-time monitoring to ensure timely identification and action against fraudulent entities? ANSWER THE MINISTER OFHEALTH AND FAMILYWELFARE (SHRI JAGAT PRAKASH NADDA)

(a) to (e) AStatement is laid on the Table of the House.STATEMENT REFERRED TO IN REPLYTO LOK SABHA STARRED QUESTION NO. 214 * FOR 13TH FEBRUARY, 2026

(a) to (e) Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is governed on a zero-tolerance approach towards fraud. National Anti-Fraud Unit (NAFU) uses AI/ML-based automated triggers to flag unusual claim patterns such as duplicate entries, inflated procedures, or misuse of patient identity, etc. Regular capacity-building workshops and field-level training sessions are conducted to strengthen the overall anti-fraud framework of AB-PMJAY.

NAFU works in close coordination with the State Anti-Fraud Units (SAFU) to investigate and take action against cases of fraud. Cases flagged as suspicious by the automated triggers are routed to the respective State Health Authorities for adjudication. Appropriate actions including suspension, issuance of show cause notices, warning letter, de-empanelment of hospitals, levying penalty lodging of FIRs are taken against fraudulent entities.

In Andhra Pradesh, 3 hospitals have been de-empanelled, 59 hospitals suspended and 360 hospitals have been levied penalty amounting to Rs. 39.23 crore during the last five years forvariousviolations.Thedistrict-wisedetailsofsuchactiontakenareatAnnexure.Annexure District-wise detail of action taken against hospitals in the State of Andhra Pradesh during the last five years (FY 2020-21 to FY2024-25) District Total numberof Total amountof Numberof Numberof hospitalson penaltylevied hospitals hospitals whichpenalty (Rupeesincrore) suspended de-empanelled hasbeenlevied ANAKAPALLI 2 0.02 - - ANANTHAPURAMU 22 1.74 6 - ANNAMAYA 6 0.04 - - CHITTOOR 6 0.21 - - DR. BR AMBEDKAR 8 0.01 - - KONASEEMA EASTGODAVARI 17 0.31 14 - ELURU 3 0.27 1 - GUNTUR 30 11.90 4 - KAKINADA 14 0.37 - - KRISHNA 1 0.01 1 - KURNOOL 27 6.58 2 - NANDYALA 3 0.19 1 - NTR 22 0.40 - - PALNADU 23 0.76 1 1 PRAKASAM 13 0.12 1 - SPSRNELLORE 23 1.14 1 - SRISATHYASAI 6 0.68 - 1 SRIKAKULAM 8 0.16 - - TIRUPATI 33 0.95 1 1 VISAKHAPATNAM 52 11.39 4 - VIZIANAGARAM 2 0.07 - - WESTGODAVARI 15 0.15 2 - YSRKADAPA 24 1.78 20 - *****