Flying Squads, Audits & AI Tools: Govt Steps Up Fraud Checks Under Ayushman Bharat

As Ayushman Bharat grows into one of the world’s largest health insurance programmes, the scrutiny of claims is intensifying, a government report shows.

Tighter fraud detection under the Narendra Modi government’s flagship health insurance scheme, Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana, has led to suspicious claims worth Rs 272 crore being flagged, with Rs 133.6 crore rejected before payment, according to the latest government data. The measures, outlined in the annual report of the National Health Authority for the year 2024-25, seen by News18, are claimed to be aimed at safeguarding the scheme’s integrity as its scale and reach expand rapidly.

Between September 2023 and March 2025, authorities deployed 61 trigger-based techniques

to identify irregularities, including 14 tools based on artificial intelligence, machine learning, image analytics and optical character recognition. During this period, the report said, over 4.63 lakh suspicious claims were shared with states for further investigation. The report says these interventions have helped contain potential losses and strengthen trust in the programme.

Oversight mechanisms have also been reinforced, the report claimed. A transaction-based analytical dashboard has been rolled out, while 2,283 desk medical audits have been conducted across states. In addition, the National Anti-Fraud Unit has carried out around 120 joint field medical audits across multiple states and Union Territories, with suspicious hospitals and entities referred to state authorities for action.

The document underlines that institutionalising a robust anti-fraud framework will be “central to sustaining the programme’s credibility”. “Going forward, predictive analytics, real-time monitoring, and automated checks to proactively detect, deter, and address suspicious activities and fraudulent claims will be further strengthened,” it said.

Some of the latest initiatives include a multi-layered anti-fraud model in Madhya Pradesh, a cross-district flying squads for fraud detection in Haryana, home visits by audit teams and flying squads in Punjab, a hospital visit monitoring system (HVMS) for real-time audit tracking in Gujarat and geo-tagged verification of beneficiaries in Manipur.

Hospital Admissions Surge Over 50 Times

Hospital admissions under AB PM-JAY have risen more than 50 times since the scheme’s launch, the government data shows. According to the report, admissions climbed from 18 lakh in 2018–19 to 9.19 crore by March 31, 2025, reflecting rising confidence and reliance on the government-funded health insurance programme among eligible beneficiaries.

The scale-up has accelerated in recent years. In 2024–25, 2.4 crore hospitalisations were recorded under the scheme, with claims amounting to over Rs 38,000 crore, highlighting its “pivotal role” in financing secondary and tertiary care for millions of low-income families.

Women Using Scheme More Than Men

Beyond volumes, official data point to a gradual narrowing of gender gaps in access to healthcare. The share of women beneficiaries has increased from 47 per cent in 2019–20 to 50 percent in 2024–25. “AB PM-JAY has not only provided quality healthcare, but it has also emerged as a tool for reducing gender disparities in accessing healthcare services,” the report said.

Several states and Union Territories have reported higher utilisation rates among women than men, indicating progress towards more equitable access across genders. The data shows women have used the scheme more than men in Goa, Puducherry, Maharashtra, Sikkim, Bihar, Chandigarh, Himachal Pradesh, Haryana, Kerala, Gujarat, and several other states. The report highlighted “the progressively narrowing of the gender gap in healthcare access across states”, calling it evidence of the scheme’s success in promoting inclusivity and addressing long-standing inequities.

Next Target: 100% Saturation Of Cards

Looking ahead, the report said the government has identified “100 per cent saturation of Ayushman cards” across all implementing states and Union Territories as a key priority. “Achieving 100% saturation of Ayushman cards across all implementing States and Union Territories continues to be a key priority,” the report said.

“Targeted efforts will be undertaken to identify and enroll all eligible beneficiaries, particularly in remote and underserved areas, to ensure equitable access to healthcare benefits under the scheme.”