NHA de-empanels over 2,000 hospitals in fraud crackdown under AB PM-JAY: Report
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The report states that these steps were intended to bolster the integrity of the government’s premier health insurance program.
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RAJEEV BHATT
During 2025‑26, the National Health Authority removed 2,003 hospitals from its panel and suspended an additional 839 as part of its drive against fraud and abuse in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB‑PM‑JAY), according to the NHA Annual Report 2025‑26.
The National Anti‑Fraud Unit (NAFU), responsible for fraud detection and enforcement within the programme, carried out the action. According to the report, NAFU levied penalties amounting to ₹114.06 crore on hospitals after continuous monitoring, investigations, medical audits, trigger‑based reviews and close cooperation with states and Union Territories.
The report notes that these steps were designed to fortify the integrity of the government’s flagship health insurance scheme by spotting irregularities and acting against hospitals that breach programme guidelines.
The NHA further stated that NAFU protected ₹678.47 crore of scheme funds by detecting suspected fraudulent claims and averting losses. The excerpt, however, does not detail the precise nature of those claims or how many cases were involved.
To boost fraud detection, NAFU launched a Hospital Vulnerability Index Dashboard—a data‑driven tool that pinpoints high‑risk and potentially vulnerable hospitals within the AB PM‑JAY network.
The authority also created a live Medical Oncology Utilisation Dashboard to track package usage and service‑delivery trends under the scheme. This dashboard gives states and Union Territories near‑real‑time insight into utilisation patterns, helping spot anomalies and strengthen oversight.
The report adds that NAFU reinforced the anti‑fraud governance framework by holding regular review meetings with states and Union Territories, launching an ‘Audit of Audit’ initiative, and running capacity‑building programmes to enhance enforcement and oversight.
According to the NHA, the anti‑fraud unit blended data analytics, focused medical audits and reinforced governance mechanisms to protect public money, shield legitimate beneficiaries and enhance the integrity of the Ayushman Bharat health insurance programme.
Published on July 20, 2026
