The government has taken decisive action to protect beneficiaries of the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) from fraudulent practices. According to a recent statement in the Lok Sabha, 1,114 hospitals have been de-empanelled, 1,504 facilities have been fined ₹122 crore, and 549 hospitals have been suspended for misuse of the scheme.
National Anti-Fraud Unit Leads Crackdown
The National Anti-Fraud Unit (NAFU) is at the core of this action, enforcing the scheme’s zero-tolerance policy against fraud. Its role is to detect, prevent, and deter irregularities in the Ayushman Bharat Health Insurance Scheme, ensuring that only genuine beneficiaries and hospitals receive benefits.
Hospitals cannot Deny Treatment.
Under the AB-PMJAY empanelment terms, hospitals are required to provide cashless treatment to eligible beneficiaries. Any denial of treatment can be reported through the Ayushman Bharat grievance redressal system.
Three-Tier Grievance Redressal System
Beneficiaries can file complaints at the district, state, and national levels via:
- The online grievance portal
- Central helpline 14555
- Email or state health agencies
Faster Claim Settlements
The National Health Authority (NHA) has set timelines for hospital claim settlements, 15 days for intra-state claims and 30 days for portability cases. The turnaround time for settlements has improved year after year, thanks to regular reviews and capacity-building programs.
With these measures, the government aims to keep the Ayushman Bharat -PMJAY free from misuse, protect public funds, and ensure beneficiaries get timely, transparent healthcare services.
yourpolicyguide.in 
Leave a comment