AB-PMJAY guideline violations: Over 2,000 hospitals de-empanelled, 1,200 suspended, says Nadda

Over 2,000 hospitals have been de-empanelled and 1,200 others suspended by states and Union Territories for violating guidelines under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) till May 31 this year, Union Health Minister J P Nadda told the Lok Sabha on Friday.

In a written reply, Nadda said 2,359 hospitals have been de-empanelled for violations, 29 FIRs have been filed, and penalties amounting to Rs 328.49 crore have been levied for breaches of scheme guidelines.

How are fraudulent claims detected?


The scheme follows a zero-tolerance approach towards fraud, Nadda said, with the National Anti-Fraud Unit under the National Health Authority (NHA) using Artificial Intelligence and Machine Learning-based automated triggers to detect suspicious claims. These checks flag unusual claim patterns, including unauthorised billing, duplicate entries, inflated procedures and misuse of patient identity, within 24 hours of claim submission, he said.

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Claims flagged as suspicious are examined before payment, and those confirmed fraudulent are not paid, resulting in savings of Rs 676.14 crore as on July 31, 2026, the minister said. Besides suspension and de-empanelment, other actions such as penalties and FIRs are taken against hospitals found violating guidelines, he added.

AB-PMJAY provides cashless health insurance coverage of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to the bottom 40 per cent of India's population. The scheme is implemented across all states and UTs, with several states integrating it with their own health insurance schemes.

During 2025-26, 3.75 crore Ayushman cards were created for eligible beneficiaries, 2.74 crore hospital admissions were authorised, and 5,074 hospitals were empanelled under the scheme, Nadda said. The Centre also released Rs 8,438.27 crore to states and UTs during the year for implementation, he said, adding that fund release is demand-driven and based on utilisation certificates and requirements projected by states and UTs.

95.99 crore ABHA IDs created so far

In response to a separate question, Nadda said 95.99 crore Ayushman Bharat Health Accounts (ABHA) had been created across the country as on July 31, 2026, including 5.25 crore in Gujarat.

ABHA, a key component of the Ayushman Bharat Digital Mission (ABDM), is a unique 14-digit health identifier that enables citizens to securely access and manage their digital health records across the healthcare ecosystem, he said.

The minister also informed the House that parliamentary constituency-wise data on ABHA creation is not maintained.

(With inputs from PTI)