New Delhi, Feb 4 Aadhaar authentication, Artificial Intelligence-based technology is preventing the misuse of Under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), said Prataprao Jadhav, Union Minister of State for Health and Family Welfare on Tuesday.
“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,” said Jadhav, in a written reply in the Rajya Sabha.
“A total of 1,114 hospitals have been de-empanelled, and 549 hospitals have been suspended under AB-PMJAY and penalties amounting to Rs 122 crore have been levied on over 1,504 hospitals,” he added.
The MoS noted that to eliminate ineligible beneficiaries from the scheme, AB-PMJAY beneficiaries are verified through Aadhaar e-KYC at the time of the creation of the card. Further, beneficiaries also must undergo Aadhaar authentication at the time of availing services. This 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,” Jadhav said.
Once the misuse is established via desk audits, field investigation appropriate action is taken. This includes disabling the Ayushman Cards, penalty, recovery, or legal action being taken against the errant entity.
This prevents any leakage or wastage of public funds. Meanwhile, Jadhav noted that AB-PMJAY also mandates a physical verification of the hospital at the time of empanelment. As per empanelment guidelines, public hospitals with inpatient services are deemed empanelled.
"NHA has launched an improved version of the Hospital Engagement Module (HEM 2.0) which mandates physical verification for private hospitals, including the submission of original photographs, latitude-longitude details of the hospital along with the physical verifier which ensures that the visit has taken place,” the Minister said, adding that HEM 2.0 has also introduced a feature that allows for periodic reviews to ensure that hospital information remains accurate.
In case of services under the scheme are not provided by the empanelled hospital, beneficiaries can lodge grievances. Under AB-PMJAY, a three-tier grievance redressal system at District, State, and National levels has been created to resolve the issues faced by beneficiaries in utilising healthcare services.
At each level, there is a dedicated nodal officer and Grievance Redressal Committees to address the grievances.
Beneficiaries can also file their grievance using different mediums including the web-based portal Centralised Grievance Redressal Management System (CGRMS), Central and State call centers, email, letters to SHAs, etc.
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