Ayushman Bharat: Big news for Ayushman Bharat card holders. The government has taken serious measures against hospitals that have breached the regulations of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). According to Union Health Minister J.P. Nadda, in a response given in the Lok Sabha on August 7, a total of 2,359 hospitals have been removed from the scheme, while 1,200 hospitals have been temporarily suspended due to violations of the scheme’s guidelines.
To tackle cases of false claims and unauthorized billing, the government has initiated 29 FIRs. Additionally, fines totaling Rs 328.49 crore have been imposed on the erring hospitals. The government emphasizes a strict zero-tolerance approach to prevent fraudulent activities under the Ayushman Bharat scheme.
Significance for Ayushman card holders
Once a hospital is de-empanelled or suspended, it cannot provide treatment under the Ayushman Bharat Scheme. It is crucial for beneficiaries to verify the hospital’s current empanelment status before seeking treatment to avoid any issues with payment or access to benefits during treatment, especially for those seeking cashless treatment.
Utilization of AI and machine learning to combat fraud
The government is increasingly utilizing artificial intelligence (AI) and machine learning to detect fraudulent activities within the Ayushman Bharat scheme. The National Anti-Fraud Unit, operating under the National Health Authority (NHA), employs automated systems to flag suspicious claims by identifying irregular patterns like duplicate claims, misuse of beneficiary identification, suspicious billing, and unnecessary medical procedures.
Rapid identification of suspicious claims
The government claims that suspicious activities can be recognized within 24 hours of a claim being submitted. This allows for prompt investigations into questionable claims before payments are made to the hospital. The government asserts that this technology-driven system has averted potential losses of Rs 676.14 crore by July 31, 2026.
Expansion and statistics of the Ayushman Bharat scheme
Throughout the 2025-26 fiscal year, 37.5 million new Ayushman Bharat cards were issued, with 27.4 million hospitalizations approved under the scheme during the same period. The central government allocated ₹8,438.27 crore to state health agencies to support expenditures. Uttar Pradesh recorded the highest number of approved hospitalizations at 3.06 million, receiving Rs 1,047.53 crore from the central government.
Coverage and network of hospitals under the scheme
Eligible beneficiaries receive cashless health coverage of up to Rs 5 lakh per family per year at empanelled hospitals under the Ayushman Bharat scheme. The scheme encompasses over 1,900 medical procedures, with the provision for states to include additional procedures for their beneficiaries. As of August 8, 2026, there were a total of 38,437 hospitals linked to the Ayushman Bharat scheme, including 20,363 government hospitals and 18,074 private hospitals. The recent government actions underscore the enhanced monitoring efforts to address fraudulent claims and violations, emphasizing the importance for beneficiaries to verify the empanelment status of hospitals before seeking treatment using the Ayushman card.