Summary of this article
As of May 31, 2026, 2,359 hospitals have been de-empanelled and 1,200 suspended under Ayushman Bharat for guideline violations, with 29 FIRs lodged.
The National Health Authority’s AI/ML-based anti-fraud system flags suspicious claims within 24 hours.
In FY 2025–26, 3.75 crore new Ayushman cards were created and 27.4 million admissions authorised.
Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is now available across India in the empanelled public and private hospitals. While the scheme is available in all states and Union Territories (UTs), its proper implementation is yet to be fixed.
J P Nadda, Minister of Health and Family Welfare told Lok Sabha in a written reply on August 7, 2026, that the government has de-empanelled 2,359 hospitals and suspended another 1,200 hospitals across India for violating the scheme’s norms. He said the government has a zero-tolerance stance toward fraud in its flagship health insurance scheme.
According to the reply, the National Health Authority (NHA) has integrated advanced technology into its oversight mechanisms to deal with fraudulent medical claims and unauthorised billing. The National Anti-Fraud Unit uses artificial intelligence (AI) and machine learning (ML) to automate the system to generate triggers upon finding any unusual patterns, such as duplicate entries, misuse of patient identities, and unnecessary procedures for treatment of illness.
He said in his reply that these triggers are executed within 24 hours of a claim being submitted so that the claim can be examined before any payment is made to the hospital.
He added that this process helped the government save Rs 676.14 crore as of July 31, 2026.
However, the monitoring mechanism doesn’t end here. They extend to the administrative suspension and beyond. The minister confirmed that 29 FIRs have been lodged against the offending hospitals and penalties of a total of Rs 323.49 crore have been levied on violators. These punitive measures, he said, are efforts put in by the government to maintain the scheme’s integrity and recover misappropriated funds.
During financial year 2025-26, 37.50 million new Ayushman cards were created, 27.40 million hospital admissions were authorised, and Rs 8,438.27 crore in central funds were released to state health agencies to support the expenditure, Nadda added in his reply. The minister replied that the funding is demand-driven and NHA releases the funds based on utilisation certificates and specific demands from the states and UTs.
The beneficiaries can avail themselves of health insurance of up to Rs 5 lakh per year under the scheme. This benefit is cashless, and the coverage starts from day 1 of the registration under the scheme. Overall, the scheme covers more than 1,900 procedures; however, states are free to offer more procedures for their residents.
During FY 2025-26, the highest number of cards were created in Maharashtra (8.60 million), while Uttar Pradesh authorised the highest number of hospital admissions (3.06 million) and received Rs 1,047.53 crore from the central funds. Since the inception of the scheme in 2018, too, Uttar Pradesh has received the largest amount of funds from the Centre, totaling Rs 4,468.61 crore.
As on August 8, 2026, there are a total of 38,437 hospitals empanelled under the scheme, according to the NHA portal, of which 20,363 are public and 18,074 are private hospitals.
