Ayushman Bharat Boosts Fraud Checks with AI, Flying Squads; Rs 272 Cr Suspicious Claims Flagged

• Ayushman Bharat intensifies fraud detection, flagging Rs 272 crore in suspicious claims, with Rs 133.6 crore rejected before payment.
• The National Health Authority's 2024-25 report details 61 trigger-based techniques, including 14 AI/ML tools, to identify irregularities.
• Oversight mechanisms include a transaction-based analytical dashboard, 2,283 desk medical audits, and 120 joint field medical audits by the National Anti-Fraud Unit.
• Hospital admissions under AB PM-JAY surged over 50 times, from 18 lakh in 2018-19 to 9.19 crore by March 31, 2025.
• The scheme shows a narrowing gender gap, with women beneficiaries increasing to 50% in 2024-25, and higher utilization rates in several states.

Why It Matters: Ayushman Bharat strengthens fraud detection with advanced tools and audits, ensuring scheme integrity amid massive growth.