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Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme, state health agencies have taken appropriate action against over 1.6 lakh claims worth Rs 287 crores as of August 5. Union Health Minister Mansukh Mandaviya informed the Lok Sabha about the measures to ensure scheme compliance.
De-Empanelment and Suspensions of Hospitals
Mandaviya revealed that 210 hospitals have been de-empanelled and 188 hospitals suspended due to their involvement in activities that do not align with the guidelines issued by the National Health Authority (NHA) or the state health authority.
Penalties and Fraud Prevention
To deter fraud and abuse, a penalty of Rs 20.71 crore has been imposed, with Rs 9.5 crore successfully recovered. The NHA established the National Anti-Fraud Unit (NAFU) to lead efforts in preventing, detecting, and addressing fraudulent activities within AB-PMJAY. The anti-fraud structure encompasses both central and state-level units.
Role of Technology in Fraud Detection
Artificial Intelligence (AI) and Machine Learning (ML) technologies are crucial in identifying suspicious transactions and potential fraud within the AB-PMJAY scheme. These technologies aid in preventing, detecting, and deterring healthcare frauds, thus ensuring that eligible beneficiaries receive appropriate treatment.
Ayushman Bharat Digital Mission (ABDM)
The Ayushman Bharat Digital Mission (ABDM) was introduced to facilitate the interoperability of health data within the healthcare ecosystem. ABDM's key components include the Ayushman Bharat Health Account (ABHA), Healthcare Professional Registry (HPR), Health Facility Registry (HFR), and Drug Registry. The mission aims to enhance transparency, security, inclusivity, accessibility, and citizen-centricity in healthcare.
Key Achievements of ABDM
As of August 8, 2023, notable achievements include the creation of 44,19,86,761 Ayushman Bharat Health Accounts (ABHAs), registration of 2,15,250 health facilities on the Health Facility Registry (HFR), enrollment of 2,13,784 healthcare professionals on the Healthcare Professional Registry (HPR), and linking 29,28,29,789 health records with ABHAs.
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme and the Ayushman Bharat Digital Mission (ABDM) collectively aim to provide comprehensive healthcare coverage, prevent fraud, and enhance the overall healthcare experience for citizens.