Lok Sabha Question No. 214 (STARRED), answered on 2026-02-13
Subject: Irregularities in AB-PMJAY
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Shri Lavu Sri Krishna Devarayalu

## GOVERNMENTOFINDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENTOFHEALTH AND FAMILYWELFARE

## LOK SABHA STARRED QUESTION NO. *214 TO BE ANSWERED ON THE 13 TH FEBRUARY, 2026

## IRREGULARITIES IN AB-PMJAY

## *214. SHRI LAVU SRI KRISHNA DEVARAYALU:

Will the MINISTER OF HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government has received cases/complaints of irregularities or violations done by hospitals in Andhra Pradesh under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) scheme;
- (b) if so, the details thereof alongwith the nature of such violations;
- (c) the details of actions taken against such hospitals in the said State, specifically the total number of hospitals de-empanelled, suspended or penalised along with the amount of penalty levied, during the last five years, district-wise;
- (d) the details of the specific methods and technologies employed by the National Anti-Fraud Unit (NAFU) to detect and prevent fraudulent activities under the scheme; and
- (e) the details of the coordination mechanism adopted by NAFU with the State Anti-Fraud Units (SAFU) in terms of data sharing, investigation protocols and real-time monitoring to ensure timely identification and action against fraudulent entities?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE

## (SHRI JAGAT PRAKASH NADDA)

- (a) to (e) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 214 * FOR 13 TH FEBRUARY, 2026

(a) to (e) Ayushman Bharat -Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is governed on a zero-tolerance approach towards fraud. National Anti-Fraud Unit (NAFU) uses AI/ML-based automated triggers to flag unusual claim patterns such as duplicate entries, inflated procedures, or misuse of patient identity, etc. Regular capacity-building workshops and field-level training sessions are conducted to strengthen the overall anti-fraud framework of AB-PMJAY.

NAFU works in close coordination with the State Anti-Fraud Units (SAFU) to investigate and take action against cases of fraud. Cases flagged as suspicious by the automated triggers are routed to the respective State Health Authorities for adjudication. Appropriate actions including suspension, issuance of show cause notices, warning letter, de-empanelment of hospitals, levying penalty lodging of FIRs are taken against fraudulent entities.

In Andhra Pradesh, 3 hospitals have been de-empanelled, 59 hospitals suspended and 360 hospitals have been levied penalty amounting to Rs. 39.23 crore during the last five years for various violations. The district-wise details of such action taken are at Annexure .

Annexure District-wise detail of action taken against hospitals in the State of Andhra Pradesh

## during the last five years (FY 2020-21 to FY 2024-25)

| District                  |   Total number of hospitals on which penalty has been levied |   Total amount of penalty levied (Rupees in crore) | Number of hospitals suspended   | Number of hospitals de-empanelled   |
|---------------------------|--------------------------------------------------------------|----------------------------------------------------|---------------------------------|-------------------------------------|
| ANAKAPALLI                |                                                            2 |                                               0.02 | -                               | -                                   |
| ANANTHAPURAMU             |                                                           22 |                                               1.74 | 6                               | -                                   |
| ANNAMAYA                  |                                                            6 |                                               0.04 | -                               | -                                   |
| CHITTOOR                  |                                                            6 |                                               0.21 | -                               | -                                   |
| DR. BR AMBEDKAR KONASEEMA |                                                            8 |                                               0.01 | -                               | -                                   |
| EAST GODAVARI             |                                                           17 |                                               0.31 | 14                              | -                                   |
| ELURU                     |                                                            3 |                                               0.27 | 1                               | -                                   |
| GUNTUR                    |                                                           30 |                                              11.9  | 4                               | -                                   |
| KAKINADA                  |                                                           14 |                                               0.37 | -                               | -                                   |
| KRISHNA                   |                                                            1 |                                               0.01 | 1                               | -                                   |
| KURNOOL                   |                                                           27 |                                               6.58 | 2                               | -                                   |
| NANDYALA                  |                                                            3 |                                               0.19 | 1                               | -                                   |
| NTR                       |                                                           22 |                                               0.4  | -                               | -                                   |
| PALNADU                   |                                                           23 |                                               0.76 | 1                               | 1                                   |
| PRAKASAM                  |                                                           13 |                                               0.12 | 1                               | -                                   |
| SPSR NELLORE              |                                                           23 |                                               1.14 | 1                               | -                                   |
| SRI SATHYASAI             |                                                            6 |                                               0.68 | -                               | 1                                   |
| SRIKAKULAM                |                                                            8 |                                               0.16 | -                               | -                                   |
| TIRUPATI                  |                                                           33 |                                               0.95 | 1                               | 1                                   |
| VISAKHAPATNAM             |                                                           52 |                                              11.39 | 4                               | -                                   |
| VIZIANAGARAM              |                                                            2 |                                               0.07 | -                               | -                                   |
| WEST GODAVARI             |                                                           15 |                                               0.15 | 2                               | -                                   |
| YSR KADAPA                |                                                           24 |                                               1.78 | 20                              | -                                   |

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