Maharashtra to Deploy AI, Flying Squads to Curb Fraud Under MJPJAY and Ayushman Bharat
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Replying to a calling attention motion, Abitkar said the government has upgraded from the legacy Jeevandayee portal to the AI-enabled KMS 2.0 platform, which has already identified suspicious treatment patterns and fraudulent claims.
The Maharashtra government will deploy AI-based monitoring, flying squads, and a real-time dashboard to strengthen fraud detection under the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) and Ayushman Bharat schemes, Health Minister Prakash Abitkar announced in the state legislative assembly on Wednesday.
Replying to a calling attention motion, Abitkar said the government has upgraded from the legacy Jeevandayee portal to the AI-enabled KMS 2.0 platform, which has already identified suspicious treatment patterns and fraudulent claims. Based on these findings, the health department initiated action against multiple healthcare providers.
"We have shifted from the old Jeevandayee portal to the AI-enabled KMS 2.0 platform. AI itself has detected suspicious claims and treatment patterns. Whoever is found guilty, irrespective of who they are, will face strong action," Abitkar said.
The minister said flying squads will conduct surprise inspections at hospitals empaneled under MJPJAY and Ayushman Bharat to identify malpractice and take immediate action. In addition, the government plans to introduce a real-time monitoring dashboard to improve transparency and oversight of the state's cashless health insurance program.
According to Abitkar, most of the irregularities currently under investigation relate to the earlier Jeevandayee portal. The new AI-powered system is capable of detecting anomalies, including instances where the same patient appears to have undergone surgeries at multiple hospitals.
The minister confirmed that action has already been initiated against four hospitals—Shiv Multispeciality Hospital and Critical Care, Rishikesh Hospital, Magnum Multispeciality Hospital, and Sant Krupa Multispeciality and Accident Hospital. He added that more hospitals could face scrutiny as investigations continue.
Abitkar also reiterated that hospitals empaneled under the scheme are required to provide complete treatment and follow-up care without charging beneficiaries for procedures covered under the government health plan. Patients asked to pay or denied treatment can submit complaints online, through district coordinators, or directly to the state government, with every complaint to be investigated.
Addressing concerns over prolonged postings of district coordinators, the minister said transfers would be carried out where necessary to reduce the risk of malpractice. He also assured lawmakers that officials found involved in irregularities would face action.
During the discussion, BJP MLA Rahul Aher called for a Special Investigation Team (SIT) and an Economic Offences Wing probe, alleging that nearly 9,000 claims from 95 hospitals were linked to a single mobile number and raising concerns over the scale of suspected fraud.
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