Ayushman Bharat Fraud: Rs 122 Cr In Fines, 1,114 Hospitals Out. But Is Aadhaar Authentication Denying Genuine Patients?

The National Health Authority (NHA) de-empanelled 1,114 hospitals, suspended 549 hospitals and levied fines of Rs. 122 crore on over 1,504 hospitals for misusing the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). AB-PMJAY is a health insurance scheme that provides a yearly cover of Rs. 5 lakh to economically vulnerable families.

The Union Minister of State for Health and Family Welfare, Prataprao Jadhav, revealed this information in a response to a question in Rajya Sabha on February 4.

The question, asked by Aam Aadmi Party MP Raghav Chadha, sought to interrogate the government over discrepancies in the scheme. He asked:

• whether Government is aware of discrepancies in the implementation of public health schemes particularly Ayushmaan Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) as highlighted by CAG Report, including cases of ineligible beneficiaries receiving benefits;
• the details of such discrepancies reported under AB-PMJAY or other national health schemes in the past five years;
• the steps taken to identify and eliminate ineligible beneficiaries from these schemes;
• whether Government has a mechanism to ensure accountability and prevent misuse of public health funds; and
• the outcomes of any recent audits or corrective measures undertaken?

The government stated that it verifies AB-PMJAY beneficiaries through Aadhaar e-KYC at the time of the creation of the card. Further, beneficiaries have to undergo Aadhaar authentication at the time of availing services. Aadhaar-authentication helps establish the identity of the eligible beneficiary. “NHA uses artificial intelligence technologies to detect potential cases of misuse in AB-PMJAY. Technologies deployed include rule-based triggers and Machine Learning algorithms, fuzzy logic, image classification and de-duplication, etc,” said the Parliament response. The NHA then checks these potential cases through desk audits and field investigations before taking action against the offending entities by disabling Ayushman Cards, levying a penalty or through other legal options.

Why This Matters:

The government has previously often tried to use AI-based tools and Aadhar verification to remove allegedly fraudulent registrations from various welfare schemes. In November last year, the government announced that it had managed to cancel 5.8 crore “fake” ration cards through Aadhar-based KYC registrations.

However, the digitisation of the Public Distribution System (PDS) has also led to a number of ration cards being scrapped and people being cut off from much needed welfare schemes. In 2021, a woman from Jharkhand moved the Supreme Court alleging that non-linkage with Aadhar had led to the cancellation of 3 crore ration cards nationally. The petitioner also claimed that her 11-year-old daughter had died of starvation after they were denied access to the PDS. Data from the Lokniti-CSDS survey in 2019 showed that 28% of respondents were denied access to food grains over problems with their Aadhar card.

Speaking to the Caravan in 2018, economist Jean Drèze termed claims about Aadhaar verification leading to savings in government expenditure to be “nothing but government-sponsored propaganda.” He also argued that a number of the cancelled ration cards were not fake at all, but legitimate ones that had been cancelled as part of routine processes.

The point here is that Aadhar verification for welfare schemes is risky and prone to false positives that can have real consequences for beneficiaries. This is even more concerning now that the government has allowed private companies to carry out Aadhaar authentication as well.

Also Read:

• LinkedIn introduces Aadhaar enabled-ID Verification feature for Indian Members
• Section 57: Why Aadhaar Can’t Be Used As Authentication By Private Companies
• Government Allows Aadhaar E-KYC For Telecoms Despite Supreme Court Judgement Striking Down Section 57 Of Aadhaar Act 2016

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