Assam govt cracks down on Ayushman Bharat irregularities, de-empanels 8 hospitals, files FIRs
A multi-layered audit, fines totaling Rs 1.18 crore, and an AI-based anti-fraud system have been implemented to ensure transparency.
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Guwahati, Feb 19: Eight hospitals have been deempanelled, and cases have been lodged against two others, as the State government unearthed irregularities in Ayushman Bharat health scheme claims following a multi-layered, rigorous audit.
Show-cause notices have also been issued to 23 hospitals in the State, and the empanelment of eleven others has been suspended.
"The hospitals were issued show-cause notices or suspended owing to various reasons, such as out-of-pocket expenditure or billing without providing receipts for payments taken in addition to the cashless treatment. In the case of Shifa and Nobel Hospitals in Barak Valley, they were submitting false bills, and an FIR was lodged against them," an official source told The Assam Tribune.
"Fines totalling Rs 1.18 crore have been collected from hospitals to date. The fines were imposed for out-of-pocket expenditures. The scheme provides for cashless benefits but hospitals were found to be charging patients out-of-pocket expenses. The payments taken from patients were returned to them from the fine amount," the official said.
While approximately 4.5 lakh claims were made last year, the official said a multi-layered audit and monitoring system has been put in place for verification.
"A back-end agency first checks the claims, which is followed by separate verification by medical and technical teams. The entire system is online," he said.
An anti-fraud unit has also been established, which rechecks a certain percentage of claims. They also conduct field verification by visiting and interacting with beneficiaries. An AI-based system also generates triggers for suspicious claims.
Over 1.72 crore Ayushman Cards have been created in Assam to date. There are 183 public and 183 private hospitals. From April 2024 to January 2025, hospital claims amounting to Rs 550.47 crore have been disbursed.
AB-PMJAY is a flagship scheme of the government, which provides health coverage of Rs 5 lakh per family per year for secondary and tertiary care hospitalization.
By Rituraj Borthakur