More than 2,300 hospitals have been de-empanelled and over 1,200 suspended under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) for violating scheme guidelines, Union Health Minister Jagat Prakash Nadda informed the Lok Sabha on August 7.
In a written reply, Nadda stated that as of May 31, 2026, a total of 2,359 hospitals had been de-empanelled by states and Union Territories. Additionally, 29 FIRs have been registered and penalties amounting to ₹328.49 crore have been imposed for violations of scheme norms.
The minister said that the National Health Authority’s (NHA) National Anti-Fraud Unit uses Artificial Intelligence (AI) and Machine Learning (ML)-based automated systems to identify suspicious claims. These systems flag unusual patterns such as unauthorised billing, duplicate claims, inflated procedures, and misuse of patient identities within 24 hours of claim submission.
According to Nadda, claims identified as suspicious are reviewed before payment, and claims confirmed as fraudulent are rejected. As of July 31, 2026, this process has resulted in savings of ₹676.14 crore. Hospitals found violating guidelines may face actions including suspension, de-empanelment, financial penalties, and legal proceedings.
AB-PMJAY provides cashless health insurance coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalisation to eligible beneficiaries. The scheme is implemented across all states and Union Territories, with several states integrating it with their own health insurance programmes.
During 2025–26, around 3.75 crore Ayushman cards were generated, 2.74 crore hospital admissions were authorised, and 5,074 hospitals were empanelled under the scheme. The Centre released ₹8,438.27 crore to states and Union Territories during the period for scheme implementation. The minister noted that fund releases are demand-driven and based on utilisation certificates and projected requirements submitted by states and UTs.
Responding to a separate query, Nadda said that 95.99 crore Ayushman Bharat Health Accounts (ABHA) had been created across the country as of July 31, 2026, including 5.25 crore in Gujarat.
ABHA, a key component of the Ayushman Bharat Digital Mission (ABDM), serves as a unique 14-digit health identifier that enables individuals to access and manage their digital health records across healthcare providers. The minister also stated that constituency-wise data on ABHA creation is not maintained.