NHA uses artificial intelligence technologies to detect potential cases of misuse, govt tells Parliament
Seven years since its inception, despite stringent checks and balances, irregularities continue to dog Pradhan Mantri Jan Arogya Yojana, the tertiary care arm of the NDA government’s flagship health programme Ayushman Bharat.
A total of 1,114 hospitals have been de-empanelled, 549 hospitals have been suspended and penalties amounting to ₹122 crore have been levied on over 1,504 hospitals, ministry of health and family welfare told the Rajya Sabha on Tuesday. Under PMJAY, eligible families are entitled to an annual health cover of Rs 5 lakh per year.
“To eliminate ineligible beneficiaries from the scheme, AB-PMJAY beneficiaries are verified through Aadhaar e-KYC at the time of 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,” MoS health Prataprao Jadhav said in written reply.
To eliminate ineligible beneficiaries from the scheme, AB-PMJAY beneficiaries are verified through Aadhaar e-KYC at the time of creation of the card
He added: “National Health Authority (NHA) has adopted a zero-tolerance policy towards misuse and abuse and has been taking steps for prevention, detection, and deterrence of different kinds of irregularities that could occur in AB-PMJAY at different stages of its implementation. 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.”
Cases of misuse of PMJAY have been reported from various states. In the most recent instance, a hospital in Gujarat was found to be doing angioplasties in people who did not need them as the public health insurance programme was paying. The matter came to light when some of the patients expired and scrutiny of documents revealed that the test reports did not back up the need for angioplasty.
