Health Minister Prakash Abitkar warns strict action against hospitals and officials involved in irregularities under Mahatma Jyotiba Phule Jan Arogya Yojana
In a major step to strengthen oversight of the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), the Maharashtra Government has announced the deployment of flying squads, Artificial Intelligence (AI)-based monitoring systems, and a real-time dashboard to detect fraud and prevent irregularities in the state-run cashless health insurance scheme.
Making the announcement in the Maharashtra Legislative Assembly on Wednesday, Health Minister Prakash Abitkar said the government would take strict action against hospitals and officials found guilty of defrauding beneficiaries under the MJPJAY and Ayushman Bharat schemes.
Flying Squads to Conduct Surprise Inspections
Replying to a calling attention motion in the Assembly, Abitkar said dedicated flying squads would carry out surprise inspections at empanelled hospitals across the state.
The teams will investigate complaints, detect malpractice and initiate immediate action against healthcare facilities found violating scheme guidelines or indulging in fraudulent practices.
The minister stressed that the government would not spare anyone involved in misuse of public healthcare funds.
AI-Based KMS 2.0 Platform Detecting Fraud
Abitkar informed the House that Maharashtra has replaced the earlier Jeevandayee portal with the AI-enabled KMS 2.0 platform, significantly enhancing the state’s ability to identify suspicious claims.
According to the minister, the AI-powered system has already detected abnormal treatment patterns and fraudulent insurance claims without requiring external complaints.
He said the technology can identify anomalies such as instances where the same patient appears to have undergone surgeries at multiple hospitals, allowing authorities to detect potential fraud at an early stage.
Real-Time Dashboard to Improve Transparency
To further strengthen monitoring, the government will introduce a real-time digital dashboard that will track the implementation of MJPJAY and improve transparency in claim processing and hospital performance.
The dashboard is expected to help officials monitor suspicious activities more effectively while ensuring timely intervention wherever irregularities are detected.
Action Initiated Against Four Hospitals
The Health Minister informed the Assembly that action has already been initiated against four empanelled hospitals over alleged irregularities:
- Shiv Multispeciality Hospital and Critical Care
- Rishikesh Hospital
- Magnum Multispeciality Hospital
- Sant Krupa Multispeciality and Accident Hospital
He added that the ongoing investigation may bring additional hospitals under scrutiny if further evidence of malpractice emerges.
Hospitals Cannot Charge Beneficiaries
Reiterating the obligations of empanelled hospitals, Abitkar said healthcare facilities participating in the scheme are required to provide complete treatment and follow-up care without charging beneficiaries for procedures covered under MJPJAY.
He urged patients who are denied treatment or asked to pay for covered services to file complaints through the online grievance portal, district coordinators or the state government.
The minister assured legislators that every complaint would be investigated.
Officials Also Under Scanner
The government also indicated that officials responsible for monitoring the scheme would face scrutiny.
Responding to concerns about district coordinators serving in the same district for extended periods, Abitkar said transfers would be carried out wherever necessary to prevent the development of unhealthy practices.
He assured the Assembly that strict action would be taken against any official found complicit in irregularities.
Demand for SIT Probe Raised in Assembly
During the discussion, BJP MLA Rahul Aher demanded a Special Investigation Team (SIT) inquiry along with an investigation by the Economic Offences Wing (EOW).
He alleged that nearly 9,000 insurance claims from 95 hospitals were linked to a single mobile number, raising serious questions about the scale of suspected fraud involving government funds.
Aher also alleged that certain district coordinators sought illegal favours from hospitals seeking empanelment under the scheme and called for their immediate transfer.
Responding to these concerns, Health Minister Prakash Abitkar assured the House that all allegations would be thoroughly examined and that stringent action would be taken against hospitals, officials or any other individuals found guilty of violating the provisions of the Mahatma Jyotiba Phule Jan Arogya Yojana.
