Unmasking Fraud: How AI is Revolutionising Ayushman Bharat Health Insurance

Date : 10/08/2023
Read: 3 mins

How AI is helping to prevent fraud under Ayushman Bharat, India's largest health insurance scheme. Read this article to learn more about the features and benefits of PMJAY.

Imagine a health insurance scheme that covers over 24 crore Indians, provides free treatment up to Rs 5 lakh per family per year, and uses cutting-edge technology to prevent fraud and ensure quality. Sounds too good to be true, right? Well, that’s exactly what the Govt’s Ayushman Bharat scheme (or Pradhan Mantri Jan Arogya Yojana) is all about. In this article, we will explore how the Govt is using AI and ML to safeguard this ambitious program, and what are its features and benefits for the common people.

Highlights:

Health insurance scheme covers 24 crore Indians.
Free treatment up to Rs 5 lakh per family.
AI used to prevent fraud in Ayushman Bharat Scheme.
Cashless treatment at any empanelled hospital.
All pre-existing conditions covered from day one.

Also Read: Pradhan Mantri Jan Arogya Yojana: What you need to know

Ayushman Bharat is a game-changer for healthcare in India. It is the world's largest health insurance scheme, and it has the potential to provide affordable and quality healthcare to millions of Indians. The scheme uses cutting-edge AI and ML technology to prevent fraud and ensure quality, and it has already recovered Rs 9.5 crore from fraudsters. Ayushman Bharat is a truly ambitious program, and it has the potential to revolutionise healthcare in India.

Using AI to prevent fraud in Ayushman Bharat Scheme

The AI is being used by the government to detect fraudulent claims, ensuring that the scheme is used for its intended purpose and that eligible beneficiaries receive the care they need. The Govt has recovered Rs 9.5 crore from fraudsters who misused the Ayushman Bharat scheme, which provides health insurance to millions of Indians. The Govt is using AI to detect and prevent fraud, and has disabled 5.3 lakh cards and de-empanelled 210 hospitals.

Introduction to Ayushman Bharat Scheme

Ayushman Bharat Scheme is a health insurance scheme launched by the Govt in 2018. It covers secondary and tertiary care services for the poor and vulnerable population. It provides free treatment up to Rs 5 lakh per family per year. A total of 24.33 crore Ayushman cards have been created.

Key Features of Ayushman Bharat Scheme

Beneficiary gets cashless treatment at any empanelled hospital.
It covers diagnostics and medicines for 3 days before and 15 days after hospitalisation.
No limit on family size, age or gender.
All pre–existing conditions are covered from day one.
Beneficiary can choose any Indian public or private hospital.
Services include about 1,929 procedures with all treatment costs.
Public and private hospitals are paid equally.
The beneficiaries will not be required to pay any fees / premiums for the expenses related to their hospitalisation.