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Report by CAG Exposes Fraud in Ayushman Bharat Scheme Treatment Records

AI/MLReport by CAG Exposes Fraud in Ayushman Bharat Scheme Treatment Records

A Comptroller and Auditor General of India (CAG) report unveiled patients initially declared deceased continuing to receive treatment through Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY). Fraud was most prevalent in Chhattisgarh, Haryana, Jharkhand, Kerala, and Madhya Pradesh. The audit identified 88,760 deceased patients who were allegedly treated under the scheme, with 3,903 questionable claims amounting to ₹6.97 crores. The report highlighted flaws allowing patients simultaneous admission to multiple hospitals. While the National Health Authority (NHA) cited reasons for these discrepancies, CAG’s analysis contradicted them, revealing 78,396 cases of overlapping claims. In response, the Government of India has adopted Artificial Intelligence and Machine Learning to detect and prevent fraudulent transactions, ensuring proper treatment under AB-PMJAY. As of August 1, 2023, over 23.33 crore Ayushman cards were issued.

By FCCT Editorial Team

Disclaimer: The views expressed in this article are independent views solely of the author(s) expressed in their private capacity.

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