Ayushman Bharat Yojana: AI-Powered Tool To Help Government Identify Manipulated Billing And Fake Claims

Under the Ayushman Bharat Yojana, around 40,000 claims are processed every day. This scheme is one of the largest public healthcare schemes globally, as per the Ministry of Health and Family Welfare. The scheme is now set to adopt artificial intelligence (AI)-based measures to enhance the claim management and root out malpractice within the settlement system.

In the AB PM-JAY Auto-Adjudication Hackathon Showcase 2026, organised by the Ministry of Health and Family Welfare (MoHFW), the National Health Authority (NHA), IndiaAI Mission, and the Indian Institute of Science (IISc), in Bengaluru, on May 8, 2026, the  Centre presented AI-based models and tools that can target and identify everything from forged medical papers, manipulated hospital bills, to non-existing beneficiaries, a critical gap in the administration of the Ayushman Bharat scheme.

The aim is to stop systemic leakage of funds and ensure that the scheme’s funds are used to benefit the genuine beneficiaries.

There have been cases where the empanelled hospital under the scheme presented inflated or forged bills and performed unnecessary procedures just to make money by getting them reimbursed from the scheme’s funds.

At the two-day event starting from May 8, several AI technologies and models have been showcased on the first day. According to the Times of India report, one of them was an advanced multilingual Optical Character Recognition (OCR) system. These systems are designed to scan and classify various medical documents and extract data from degraded records, which might otherwise be difficult to verify. Further, these AI tools can also help find out when there is a deviation in a treatment guideline. For example, the AI model will be able to find out when a hospital has overbilled for the procedure or has prescribed unnecessary procedures. These AI models are aimed at preventing such malpractices and curbing the misuse of funds.

One of the other AI models showcased the ability to analyse diagnostic imagery reports, such as X-rays, MRIs, and CT scans, to verify that the diagnosis and the subsequent treatment performed by the hospital are aligned and medically sound.

In addition to it, the teams also presented AI models that can identify deepfake technology used to generate forged medical documents, discharge summaries, and billing documents.

The government’s focus is to create a health AI benchmarking platform using India-specific datasets that is tuned to the medical issues of the Indian population and the administrative realities.

In this Hackathon, over 3,500 participants registered through the digital portal to showcase their AI models to improve India’s healthcare system and public healthcare insurance processes.

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