According to the report, these measures were aimed at strengthening the integrity of the government’s flagship health insurance scheme.
| Photo Credit:
RAJEEV BHATT
The National Health Authority (NHA) de-empanelled 2,003 hospitals and suspended another 839 during 2025-26 as part of its crackdown on fraud and misuse under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), NHA Annual Report 2025-26 has said.
The action was taken by the National Anti-Fraud Unit (NAFU), which oversees fraud detection and enforcement under the scheme. The report said the unit imposed penalties worth ₹114.06 crore on hospitals following sustained monitoring, investigations, medical audits, trigger-based scrutiny and close coordination with states and Union Territories.
According to the report, these measures were aimed at strengthening the integrity of the government’s flagship health insurance scheme by identifying irregularities and taking action against hospitals found violating programme guidelines.
The NHA also said NAFU safeguarded ₹678.47 crore under the scheme by identifying suspected fraudulent claims and preventing financial losses. However, the report excerpt does not specify the exact nature of these fraudulent claims or the number of cases involved.
As part of efforts to strengthen fraud detection, NAFU operationalised a Hospital Vulnerability Index Dashboard, a data-driven tool to identify high-risk and potentially vulnerable hospitals within the AB PM-JAY network.
The authority also developed a live Medical Oncology Utilisation Dashboard to monitor package utilisation and service delivery patterns under the scheme. The dashboard provides states and Union Territories with near real-time visibility of utilisation trends to help detect anomalies and improve oversight.
The report said NAFU also strengthened the anti-fraud governance framework through regular review meetings with states and Union Territories, an “Audit of Audit” initiative, and capacity-building programmes aimed at improving enforcement and oversight.
According to the NHA, the anti-fraud unit combined data analytics, targeted medical audits and strengthened governance mechanisms to safeguard public funds, protect genuine beneficiaries and improve the integrity of the Ayushman Bharat health insurance programme.
Published on July 20, 2026
