New Delhi, Aug 11: State health agencies informed the Lok Sabha on Friday that appropriate action has been taken against more than 1.6 lakh claims totaling Rs 287 crores under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme as of August 5.
In response to a question, Union Health Minister Mansukh Mandaviya stated that 210 hospitals had their accreditation revoked and 188 had their licences suspended because they had engaged in activities that were against the National Health Authority’s (NHA) or a state health authority’s rules.According to him, a fine of Rs 20.71 crore was imposed, of which Rs 9.5 crore was recovered.
According to Mandaviya, the NHA has established a National Anti-Fraud Unit (NAFU) whose main duties include preventing, detecting, and discouraging fraud and misuse under AB-PMJAY.
The NAFU is at the centre of the scheme’s anti-fraud structure, which is then followed by State Anti-Fraud Units. According to the minister, NHA uses artificial intelligence (AI) and machine learning (ML) technology to identify potentially fraudulent transactions or questionable transactions.According to him, these technologies are helpful in ensuring that eligible beneficiaries receive proper care and in the prevention, detection, and deterrence of healthcare frauds during plan implementation.
On September 23, 2018, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme was introduced with the goal of providing over 12 crore poor and vulnerable families (or roughly 55 crore beneficiaries) with a health cover of Rs 5 lakhs per family per year for secondary and tertiary care hospitalisation.According to Mandaviya, the Ayushman Bharat Digital Mission (ABDM) was established by the Indian government to provide a platform that enables the exchange of health data within the healthcare ecosystem in order to develop a longitudinal Electronic Health Record (EHR) for each individual.
The Ayushman Bharat Health Account (ABHA), Healthcare Professional Registry (HPR), Health Facility Registry (HFR), and Drug Registry are some of the important registries that make up ABDM. According to him, ABDM aims to improve healthcare by making it more open, safe, inclusive, accessible, and citizen-focused.As of August 8, 2023, 2,15,250 healthcare facilities had registered on HFR and 44,19,86,761 Ayushman Bharat Health Accounts (ABHAs) have been created overall. Additionally, according to Mandaviya, 29,28,29,789 health records have been linked with ABHA, and 2,13,784 medical practitioners have registered on HPR.
