Jammu, Feb 11: Private hospitals in Jammu and Kashmir have committed alleged fraud worth Rs 11.82 crore by presenting fake and fraudulent bills under under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) schemes.
Replying to a question in Rajya Sabha, Minister of State for Health and Family Welfare Pratap Rao Jadhav said that as many as 2. 7 lakh fake claims worth Rs 562. 4 crores made by private hospitals, were detected by the authorities.
Out of these frauds, Rs 11.82 crore fraud detected in Jammu and Kashmir.
After detecting these frauds, a total of 1,114 hospitals have been de-empanelled, and 549 hospitals have been suspended under AB-PMJAY.
Minister said that “National Anti-Fraud Unit (NAFU) has been established at National Health Authority and works in close coordination with State Anti-Fraud Units to investigate and take joint action against issues related to fraud and abuse.
Is suspension or blacklisting or de empanelment of hospitals concerned from the AB-PMJAY network serve the purpose after detecting such frauds on schemes meant for poor's.
To enhance the detection of misuse or abuse, near real-time monitoring and AI-based systems are used to check hospital claims. Furthermore, hospitals undergo random audits and surprise inspections to ensure the authenticity of claims.
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