Centre Deploys AI Tools to Crack Down on Fake Ayushman Bharat Claims

The Government of India is stepping up its battle against healthcare fraud under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) by deploying advanced Artificial Intelligence-based systems to detect fake insurance claims, forged medical records, suspicious billing patterns, and fraudulent beneficiary applications. The move marks one of the largest uses of AI-driven fraud detection in India’s public healthcare ecosystem and reflects the government’s broader push toward technology-enabled governance and digital oversight.

According to reports, the Centre is integrating AI-powered analytics into the claims adjudication process under Ayushman Bharat to improve transparency, reduce financial leakages, and accelerate the settlement of legitimate insurance claims. The initiative is being led through the National Health Authority (NHA), which administers the world’s largest government-funded health insurance programme.

The AI systems are designed to identify abnormal claim patterns that may indicate misuse or deliberate fraud. These include suspiciously repeated procedures, inflated hospital stays, forged medical documents, duplicate beneficiary entries, deviations from approved treatment guidelines, and unusual billing behaviour by hospitals or intermediaries. The technology can reportedly analyse massive volumes of healthcare data in real time and automatically flag anomalies for investigation.

Officials associated with the programme have stated that leakages in large public healthcare systems are a major challenge globally and that India’s rapidly expanding digital health infrastructure now provides the opportunity to deploy AI for proactive monitoring and financial oversight. The government believes such systems can significantly strengthen programme integrity while ensuring that public funds reach genuine beneficiaries.

The latest push comes amid a broader national effort to automate claims processing under Ayushman Bharat through AI-enabled “auto-adjudication” systems. The National Health Authority recently organised the AB PM-JAY Auto-Adjudication Hackathon Showcase 2026 in collaboration with the Ministry of Health and Family Welfare, IndiaAI Mission, and the Indian Institute of Science (IISc), Bengaluru. The event showcased advanced AI and machine-learning solutions capable of automating document verification, multilingual Optical Character Recognition (OCR), fraud detection, and compliance analysis.

One of the major focus areas of the initiative is the use of AI to process low-quality and heterogeneous medical documents, including scanned reports and handwritten records. The systems can extract structured clinical and billing data, track inconsistencies, and assign confidence scores to claims. Officials say this could drastically reduce manual verification workload and improve the speed and accuracy of claim approvals.

The government is also exploring the use of Small Language Models (SLMs), Large Language Models (LLMs), and multimodal AI systems for healthcare administration in low-resource and multilingual environments. Discussions during the hackathon highlighted the importance of scalable AI systems capable of operating across India’s highly diverse healthcare landscape while maintaining privacy safeguards and regulatory compliance.

According to officials quoted in reports, AI-enabled monitoring systems have already helped prevent misuse worth hundreds of crores of rupees under the scheme. Authorities maintain that the technology is not only aimed at curbing fraud but also at improving efficiency, reducing delays, and building trust among hospitals, insurers, and beneficiaries.

Healthcare experts believe the move could significantly modernise India’s public health-insurance administration. Fraudulent claims have long been a concern in large-scale health schemes worldwide, particularly where massive volumes of claims are processed across thousands of hospitals and service providers. AI-driven adjudication systems can potentially reduce human error, improve consistency in decision-making, and enhance real-time oversight.

The Ayushman Bharat programme currently provides health insurance coverage of up to ₹5 lakh per family annually for economically vulnerable populations and is considered one of the largest publicly funded healthcare schemes globally. As claim volumes continue to rise, the government appears increasingly focused on ensuring that digital technologies, data analytics, and artificial intelligence become central pillars of the programme’s future management architecture.