AB-PMJAY: 1,114 Hospitals De-Empanelled And 549 Suspended For Fraudulent Activities, Know How To Raise A Grievance Under The Scheme

Ayushman Bharat Yojana now covers senior citizens aged 70 years and above. They can avail of health insurance at around 31,140 empanelled hospitals, including more than 14,029 private hospitals and 17,111 public hospitals as of February 12, 2025, as per the National Health Authority’s website. The scheme provides Rs 5 lakh health insurance. It covers around 2000 treatment procedures for 27 specialities, including general surgery, cardiology, oncology, accelerated hypertension, hip replacement, total knee replacement, general medicine, etc. To avail of these treatments, one needs to show the Ayushman Card to the empanelled hospital.

However, if the hospital denies these services, or there is any other issue in the treatment, or the treatment is suggested unnecessarily, or some other issue, one can raise a grievance.

In November 2024, two patients died after undergoing angioplasty at the empanelled hospitals under the PM-JAY scheme. Allegedly, the patients did not require the procedure but the hospital performed it unnecessarily to make money, PTI reported earlier.

Recently, regarding the corrupt practices followed by hospitals in the name of Ayushman Bharat Cards, parliamentarian Geniben Nagaji Thakor asked a question in the Lok Sabha.

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Action Taken Against Hospitals And Doctors For Corrupt Practices:

Jagat Prakash Nadda, Minister Of Health and Family Welfare, in a written reply to the question, said, “Suitable actions including de-empanelment of 1114 hospitals, levying penalty worth Rs. 122 crore on 1504 errant hospitals and suspension of 549 hospitals have been taken against fraudulent entities as reported by the States/UTs. Further, any claims by empanelled hospitals found to be suspicious by NAFU are withheld until proper scrutiny by SAFU teams including field verification where necessary”.

NAFU is the National Anti-Fraud Unit at the NHA, and SAFU is the State Anti-Fraud Unit which works in coordination to investigate fraudulent matters and take action against it. The reply mentioned a ‘zero-tolerance approach’ towards any fraud or abuse in the Ayushman Bharat yojana and ensuring a ‘detention and deterrence’ of frauds from happening.

Besides this, a total of nine doctors and 71 hospitals have been suspended under the scheme in Gujarat as of February 4, 2025. In addition to this, two hospitals have been de-empanelled and one hospital has been blacklisted. Also, Rs 15.08 crore of recovery has been made and penalties worth Rs 19.90 crore have been imposed, per the reply.

While the government is de-empanelling the hospitals or putting a penalty on them, as a beneficiary of AB-PMJAY, if you face an issue, you can raise it directly with the authority.

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Helpline Number:

First of all, one can call the helpline number 1800-110-770 to get assistance on any matter related to the scheme.

How To Raise A Grievance:

However, if the query is not resolved or if the issue persists, one may call the 24-hour customer care number 14555 or send a grievance letter to the authority by post, or lodge the grievance online on the portal.

Step 1: Visit the Ayushman Bharat Digital Mission Grievance Portal

Step 2: Click ‘Register your grievance’

Step 3: Select complainant details from the drop-down menu, and provide name, mobile number, email ID and select state or union territory from the list

Step 4: Fill the grievance details describing the issues in brief

Step 5: Upload the supporting document if any, and submit

An ABDM complaint ID or a grievance tracking number will be generated. Note it for future reference. Once the grievance is acknowledged, an SMS will be sent to the complainant with the link to track the complaint status. The expected time of complaint redressal is 30 days.

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Ayushman Cards Created So Far:

The scheme, as of January 1, 2025, authorised a total of 8.59 crore hospital admissions worth Rs 1.19 lakh crore. Since its extension to seniors over 70 years of age, over 47 lakh Ayushman Vay Vandana cards have been created, as of February 6, 2025. The maximum Ayushman cards have been issued in Madhya Pradesh (13,57,998), followed by Uttar Pradesh (8,02,564) and Kerala (6,07,083).