The Enforcement Directorate (ED) has launched a major crackdown on fake medical claims under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), one of India’s largest health insurance schemes. ED officials conducted raids across Delhi and three other states — Haryana, Uttar Pradesh, and Rajasthan — after discovering that several hospitals had claimed payments for treatments that were never actually done.
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What is the Ayushman Bharat Scheme?
The Ayushman Bharat Yojana, launched in 2018, provides free healthcare services up to ₹5 lakh per family per year to poor and vulnerable families. The aim is to ensure that no one has to suffer or go into debt for medical treatment. Thousands of hospitals across the country are registered under the scheme to provide free treatment to eligible citizens.
However, recent reports suggest that the system has been misused by some hospitals, which have made fake entries and claimed payments for patients who were never admitted or treated.
What Did the ED Find?
According to ED officials, the raids were based on intelligence inputs and complaints received from various government agencies. The investigation has revealed shocking details:
Hospitals created fake patient records, including names, Aadhaar numbers, and fake medical reports. In many cases, the same patient was shown to have received treatment in two different hospitals at the same time. Claims were made for expensive treatments like surgeries, dialysis, and chemotherapy — but no real treatment happened. Some hospitals charged the government for treatment of dead people or people who were never even admitted. The ED has found evidence of money laundering, where these hospitals transferred the illegally received funds into different accounts to hide their source.
States Involved
The raids were carried out in Delhi, Uttar Pradesh, Haryana, and Rajasthan. More than 30 hospitals and diagnostic centers were searched. ED officials said that some hospitals in Delhi had claimed over ₹10 crore in just one year through fake claims.
In Uttar Pradesh and Haryana, certain private hospitals in small towns were found to be involved in mass fraud. These hospitals were working with agents who helped them get fake patient data in exchange for a commission.
Role of Middlemen and Agents
The ED has also uncovered the role of middlemen who acted as brokers between hospitals and patients. In some cases, poor people were promised free checkups or money if they gave their Aadhaar details. These details were then used to generate fake medical claims without the patients even knowing.
There are also reports that some government officials may have helped in clearing these fake claims, ignoring red flags and unusual patterns.
Government’s Reaction
The Ministry of Health and Family Welfare has taken the matter seriously. A senior official said, “This is a betrayal of the people and a misuse of a welfare scheme that was meant to help the poorest. Strict action will be taken against all those involved.”
The National Health Authority (NHA), which oversees the Ayushman Bharat scheme, has blacklisted 157 hospitals in the past for similar fraud. Now, with the ED raids confirming large-scale corruption, the NHA is expected to launch a fresh audit of claims across the country.
Arrests and Legal Action
Following the raids, several hospital owners and managers have been taken in for questioning. Bank accounts worth over ₹40 crore have been frozen. The ED has also recovered computers, hard drives, and registers with patient data which will now be examined for further evidence.
Cases will be filed under the Prevention of Money Laundering Act (PMLA) and the Indian Penal Code (IPC). If found guilty, the accused could face jail terms of up to 7 years or more.
Impact on Real Patients
While the ED’s action is necessary, the scandal has also raised concerns about genuine patients being affected. If hospitals start fearing investigation, they may become hesitant to accept patients under the Ayushman Bharat scheme.
To prevent this, the government has assured that real beneficiaries will not face any problem and that steps will be taken to make the system more transparent and secure.
What’s Next?
The ED is likely to expand the investigation to other states as well. More hospitals may be raided in the coming days. The government is also planning to bring in digital tracking systems, biometric verification, and AI-based fraud detection to avoid such scams in the future.
This incident is a reminder of how noble schemes can be misused for personal gain and why constant monitoring and accountability are essential in public welfare programs.
Against Corruption
The Ayushman Bharat scheme was introduced to bring healthcare to the doorstep of the poor, but misuse by some corrupt elements has put its credibility at risk. The ED’s action is a strong signal that fraud will not be tolerated, and strict steps will be taken to protect public money and trust.
By – Sonali
