The central government has de-empanelled 2,359 hospitals from the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) for violating scheme rules. Another 1,200 hospitals have been suspended for irregularities, Health Minister JP Nadda informed the Lok Sabha in a written reply on August 7. The move affects millions of beneficiaries who rely on the flagship health insurance program for cashless treatment.
Strict Action Against Fraud
The government has adopted a zero-tolerance policy against fraud in the scheme. Authorities have filed 29 FIRs against rule-violating hospitals and imposed a total penalty of Rs 328.49 crore. The crackdown targets false claims, incorrect billing, and other irregularities under the health insurance program. Officials say the action sends a strong message to those attempting to exploit the system.
AI-Powered Fraud Detection System
The National Health Authority (NHA) has strengthened its artificial intelligence and machine learning-based monitoring system. The system identifies suspicious patterns in hospital claims including duplicate claims, misuse of beneficiary identity, and unnecessary medical procedures. Alerts are generated within 24 hours of claim submission, enabling pre-payment verification. The technology helped prevent a potential loss of Rs 676.14 crore as of July 31, 2026.
Scheme Expansion Continues
Despite the crackdown, the Ayushman Bharat scheme continues to expand rapidly. In fiscal year 2025-26, the government issued 3.75 crore new Ayushman cards and approved 2.74 crore hospital admissions. The center released Rs 8,438.27 crore to state health agencies during this period. Uttar Pradesh registered the highest number of approved admissions at 30.6 lakh and received Rs 1,047.53 crore in central funding.
Current Coverage and Caution for Beneficiaries
As of August 8, 2026, a total of 38,437 hospitals were empanelled under the scheme, including 20,363 government and 18,074 private facilities. Eligible families receive cashless treatment worth up to Rs 5 lakh per year. Beneficiaries are advised to check the current empanelment status of hospitals before seeking treatment. Suspended or de-empanelled hospitals cannot provide cashless treatment under the scheme, and patients may face unexpected bills at such facilities.
