All claims require documents with a photograph of the patient in bed before approval. (Representative)
New Delhi:
Uses artificial intelligence and machine learning for comprehensive fraud analysis solutions to proactively detect fraud, develop algorithms that can be used on large amounts of data to identify suspicious transactions and entities, and to identify risk factors for hospitals and claims Scoring can be done. Reported on Friday.
Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is governed on a zero-tolerance approach for any fraud like claims of dubious or non-genuine medical treatment, impersonation and up-coding of treatment packages and procedures etc. , Minister of State for Health Praveen Pawar said in a written reply.
Responding to a question whether it is a fact that around 23,000 fake transactions were registered in the hospitals empaneled under AB-PMJAY in 2021-22, he said that the National Health Authority – the implementing agency of AB-PMJAY – has taken a comprehensive set is released. Anti-fraud guidelines. Anti-fraud advisory is issued to the states and union territories. National Anti-Fraud Unit has been created in the NHA for overall monitoring and implementation of the Anti-Fraud Framework supported by the State Anti-Fraud Units at the State level.
All claims require mandatory supporting documents along with a photograph of the patient in bed before approval and payment. The facility of Aadhaar-based biometric verification of beneficiary at the time of admission and discharge has been introduced in all private hospitals.
“Artificial intelligence and machine learning are used for a comprehensive fraud analysis solution to proactively detect fraud, develop algorithms that can be used to identify suspicious transactions and entities on large amounts of data, and to identify hospitals and claims.” for risk scoring.” Pawar said.
Providing details of action taken by state health agencies, he said Chhattisgarh has the highest number of claims, followed by Madhya Pradesh, Punjab, Kerala and Jharkhand with penal action taken for fraudulent hospital transactions under AB-PMJAY .
(Except for the title, this story has not been edited by NDTV staff and is published from a syndicated feed.)