Parliament Question: Medical Facilities under Ayushman Bharat Scheme

GOVERNMENTOFINDIA MINISTRYOFHEALTH AND FAMILYWELFARE DEPARTMENTOFHEALTH ANDFAMILYWELFARE LOK SABHA UNSTARREDQUESTION NO. 1100 TOBE ANSWERED ON24TH JULY,2026 MEDICALFACILITIES UNDER AYUSHMANBHARATSCHEME †1100. SHRIARUNGOVIL:

Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:

(a)the totalnumberof people who have beenprovidedmedicalfacilities underthe Ayushman Bharat Schemeso far along with the numberof hospitals where these facilitiesare available;

(b) whether the Government has any plan to provide this facility only to families with fewer thansix members;

(c) whether this facility is being provided to families having six or more members despite violate the Government's familyplanningpolicy, if so, the reasons therefor;

(d) if so, the timelinebywhich such a provision islikelytobe implemented;

(e) the action taken by the Government against hospitals that misuse this scheme by generatingfake billsto claimreimbursement;

(f) the total number of cases reportedto the Government during the last three years where the reimbursement of expenses incurred under the Ayushman Bharat Scheme took more than a month; and

(g) the total number of hospitals registered for medical treatment underthe Ayushman Bharat SchemeinMeerut Parliamentary Constituency? ANSWER THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND FAMILYWELFARE

(SHRIPRATAPRAOJADHAV)

(a): As on 30.06.2026, a total of 12.69 crore hospital admissions amounting to Rs. 1.92 lakh crore, have been authorizedunder the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY),throughthenetworkof37,413empanelledhospitalsacrossthecountry.(b)to(d):AB-PMJAYprovideshealthcoverageofRs.5lakhperfamilyperyearforsecondary andtertiary care hospitalizationto 12crore economicallyvulnerable families, constituting the bottom 40% of India's population. In March 2024, the scheme was expanded to include approximately 37 lakh families of Accredited Social Health Activists, Anganwadi Workers, andAnganwadiHelpers.

For above beneficiary categories, there is no cap on family size, age, or gender. All eligible membersofabeneficiaryfamilyareentitledtohealthcoverageunderthe scheme,irrespective oftheirageorgender.

In October 2024, the scheme was further expanded to cover 6 crore senior citizens of age 70 yearsandabovebelongingto4.5crorefamiliesirrespectiveoftheirsocio-economicstatus.

(e): AB-PMJAY is governed on a zero-tolerance approach towards the frauds. National Anti- Fraud Unit under National Health Authority uses Artificial Intelligence/Machine Learning- based automated triggers to flag unusual claim patterns such as duplicate entries, inflated procedures,ormisuseofpatientidentityetc.

Appropriate actionsincluding suspension, de-empanelment, levyingpenalty, lodgingof FIRs, etc.aretakenagainsthospitalsfoundtobeinvolvedinviolationsoftheschemeguidelines.

(f): Under the scheme, settlement of claims is a regular and uninterrupted process and claims are settled by respective State HealthAgencies asperclaim adjudication guidelinesissued by NationalHealthAuthority.Further,fortimelysettlementofclaims,thepermissibleturnaround timeiswithin15daysofclaimsubmissionforintra-statehospitals(hospitalslocatedwithinthe State) and within 30 days of claim submission in case of portability claims (hospitals located outsidetheState).

(g): The constituency-wise data is not captured under AB-PMJAY, however, the details of hospitals empanelled under AB-PMJAY in the districts covered under the Meerut Lok Sabha

Constituencyareasunder:

District No. of Hospitals Empanelled (Ason20.07.2026) Meerut 177 Hapur 59 *****