NHA Penalises 2,842 Hospitals Under Ayushman Bharat, Blocks ₹678 Cr Fake Claims

The National Health Authority took strict action in FY 2025-26 against fraud in Ayushman Bharat PM-JAY.

Key Actions:

• 2,842 hospitals penalised – ₹114.06 crore in fines
• 2,003 hospitals de-empanelled, 839 suspended
• ₹678.47 crore in bogus claims blocked before payment

How fraud was caught:

NHA used an AI-based Auto-Adjudication Engine to flag fake claims like gender mismatches, repeat surgeries, and impossible procedures. A new Hospital Vulnerability Dashboard and biometric checks for dialysis were also added.

About the scheme:

Ayushman Bharat gives ₹5 lakh cashless cover per family/year. It now covers 35,908 hospitals and has handled 11.93 crore admissions worth ₹1.78 lakh crore since 2018.