As India’s flagship health insurance scheme, Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana, scales up at an unprecedented pace, the government has stepped up efforts to prevent fraud, misuse and commercial exploitation of public funds. According to the latest annual report of the National Health Authority for 2024-25, tighter monitoring mechanisms have already led to suspicious claims worth Rs 272 crore being flagged, with Rs 133.6 crore rejected before payment. The data underlines the government’s attempt to balance rapid expansion of healthcare access with strict financial and procedural discipline.
The report outlines a multi-layered anti-fraud strategy implemented under the Narendra Modi government as the scheme transitions from its early expansion phase to long-term consolidation. Officials acknowledge that as the programme grows in scale, complexity and financial outlay, the risk of abuse by errant hospitals and intermediaries also rises, making institutionalised vigilance essential for sustaining public trust.
Between September 2023 and March 2025, authorities deployed 61 trigger-based techniques to identify irregularities in claims submitted under the scheme. These included 14 advanced tools using artificial intelligence, machine learning, image analytics and optical character recognition. During this period, over 4.63 lakh suspicious claims were flagged and shared with state governments for further investigation, reflecting the sheer volume of transactions being processed daily under the scheme.
The National Health Authority has also strengthened oversight mechanisms beyond automated tools. A transaction-based analytical dashboard has been rolled out to monitor claim patterns in real time, while 2,283 desk-based medical audits have been conducted across states and Union Territories. In addition, the National Anti-Fraud Unit carried out around 120 joint field medical audits, physically inspecting hospitals and healthcare facilities suspected of irregular billing practices. Hospitals found to be violating norms were referred to state authorities for further action, including penalties and possible empanelment suspension.
According to the report, institutionalising a robust anti-fraud framework is now central to sustaining the credibility of Ayushman Bharat. Officials have stressed that future strategies will increasingly rely on predictive analytics, real-time monitoring and automated checks to proactively detect, deter and address suspicious activities before payments are released. The aim is to move from reactive enforcement to preventive governance as transaction volumes continue to rise.
Several states have already rolled out innovative state-specific measures to strengthen enforcement on the ground. Madhya Pradesh has implemented a multi-layered anti-fraud model that combines data analytics with physical verification. Haryana has deployed cross-district flying squads to prevent local collusion and ensure independent verification of claims. Punjab has introduced home visits by audit teams and flying squads to verify beneficiary authenticity, while Gujarat has operationalised a hospital visit monitoring system that enables real-time tracking of audits. In Manipur, beneficiary verification is being carried out using geo-tagging to prevent identity misuse.
The need for such heightened vigilance becomes evident when viewed against the dramatic expansion of Ayushman Bharat since its launch. Hospital admissions under the scheme have risen more than 50 times in just a few years. From 18 lakh admissions in 2018-19, the number surged to 9.19 crore by March 31, 2025, indicating growing reliance on government-funded healthcare among economically vulnerable families.
The pace of expansion has accelerated sharply in recent years. In 2024-25 alone, 2.4 crore hospitalisations were recorded under the scheme, with claims exceeding Rs 38,000 crore. Officials describe this as evidence of Ayushman Bharat’s pivotal role in financing secondary and tertiary healthcare for millions who previously had little or no access to quality medical treatment.
Beyond sheer numbers, the data also points to important social outcomes, particularly in narrowing gender disparities in healthcare access. The share of women beneficiaries has steadily increased from 47 percent in 2019-20 to 50 percent in 2024-25. The National Health Authority has described this trend as a significant indicator of the scheme’s impact in promoting equitable access to healthcare services.
Several states and Union Territories have reported higher utilisation rates among women than men, including Goa, Puducherry, Maharashtra, Sikkim, Bihar, Chandigarh, Himachal Pradesh, Haryana, Kerala and Gujarat. Officials say this reflects increased healthcare-seeking behaviour among women and improved financial protection for families that previously postponed or avoided medical treatment due to cost constraints. The report highlights the progressively narrowing gender gap as evidence that Ayushman Bharat is addressing long-standing inequities in healthcare access.
As utilisation rises, the government is also focusing on expanding the scheme’s coverage footprint. Achieving 100 percent saturation of Ayushman cards across all implementing states and Union Territories has been identified as a key priority going forward. According to the report, targeted efforts will be undertaken to identify and enrol all eligible beneficiaries, particularly in remote and underserved areas where awareness and access remain limited.
Officials note that full saturation is essential not only for equity but also for effective governance, as comprehensive enrolment allows better tracking of beneficiaries, improved data integrity and reduced scope for impersonation or misuse. The push for saturation is expected to be accompanied by intensified outreach, coordination with state governments and integration of local administrative machinery.
The expanding scale of Ayushman Bharat has also heightened policy attention on ensuring that public funds are not diverted through inflated bills, unnecessary procedures or fake admissions. Fraud risks tend to rise sharply in large insurance-backed systems, particularly where private hospitals play a significant role in service delivery. The government’s emphasis on AI tools and field audits is therefore being viewed as a necessary corrective rather than an optional safeguard.
At the same time, officials stress that the objective is not to harass hospitals or discourage participation but to ensure ethical practices and protect genuine beneficiaries. By combining technological surveillance with human audits, the National Health Authority aims to strike a balance between efficiency and accountability.
As Ayushman Bharat enters its next phase, the challenge before policymakers will be to sustain rapid expansion while maintaining strict controls over quality, cost and integrity. The data from 2024-25 suggests that the government is increasingly aware that the long-term success of the scheme will depend not just on how many people it covers, but on how effectively it safeguards public resources while delivering timely and quality healthcare to those who need it most.
