Centre tells Lok Sabha that 2,359 hospitals have been de-empanelled and more than 1,200 suspended under AB-PMJAY, with penalties of Rs 328.49 crore imposed for violations.
2,359 Hospitals De-empanelled, Over 1,200 Suspended
As many as 2,359 hospitals have been de-empanelled and more than 1,200 suspended by states and Union Territories for violating guidelines under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Union Health Minister JP Nadda informed the Lok Sabha.
The government has also registered 29 FIRs and imposed penalties amounting to Rs 328.49 crore against hospitals and institutions found violating the scheme’s guidelines.
Zero-Tolerance Approach to Healthcare Fraud
The Centre has adopted a zero-tolerance approach towards fraud under AB-PMJAY. The National Anti-Fraud Unit of the National Health Authority (NHA) uses Artificial Intelligence and Machine Learning-based automated systems to identify suspicious claims.
According to Nadda, these automated mechanisms can flag unusual claim patterns, including unauthorised billing, duplicate entries, inflated procedures and misuse of patient identities, within 24 hours of a claim being submitted.
Suspicious Claims Undergo Scrutiny
Claims identified as suspicious are subjected to further scrutiny before payments are released. Those found to be fraudulent are rejected, resulting in savings of Rs 676.14 crore as of July 31, 2026, the minister said.
Apart from suspension and de-empanelment, authorities can impose financial penalties and register FIRs against hospitals and institutions found violating AB-PMJAY guidelines.
3.75 Crore Ayushman Cards Issued in 2025-26
During the 2025-26 financial year, a total of 3.75 crore Ayushman cards were issued to eligible beneficiaries, while 2.74 crore hospital admissions were authorised under the scheme.
During the same period, 5,074 hospitals were empanelled under AB-PMJAY. The Centre released Rs 8,438.27 crore to states and Union Territories for implementation of the scheme.
Nadda said the release of funds is demand-driven and depends on utilisation certificates as well as the requirements projected by states and Union Territories.
AB-PMJAY Provides Up to Rs 5 Lakh Health Cover
AB-PMJAY is the Centre’s flagship health assurance programme and provides cashless health coverage of up to 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 being implemented across all states and Union Territories, with several states integrating it with their own health insurance programmes.
Over 95 Crore ABHA Accounts Created
Responding to another question, the Union Health Minister 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), is a unique 14-digit health identifier that enables citizens to securely access and manage their digital health records across the healthcare ecosystem.
The minister clarified that parliamentary constituency-wise data on ABHA account creation is not maintained.
