Flying Squads, AI to Help Detect Frauds in Maharashtra Govt Health Scheme: Minister

Maharashtra Health Minister Prakash Abitkar on Wednesday warned that the government "will not spare anyone" found guilty of defrauding the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) and assured deploying modern tools to detect frauds in the state-run scheme.

He announced the deployment of flying squads, AI-based monitoring and strict action against erring hospitals and officials, saying the health department had itself detected several irregularities through technology.

Replying to a calling attention motion in the legislative assembly, Abitkar said flying squads would be deployed under the MJPJAY and Ayushman Bharat schemes to conduct surprise inspections and take immediate action against hospitals indulging in malpractice.

"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. The health department took suo motu (on its own) action after these irregularities came to light. Whoever is found guilty, irrespective of who they are, will face strong action," the minister said.

Abitkar said the government would also introduce a real-time monitoring dashboard to improve transparency and oversee implementation of the cashless health insurance scheme (MJPJAY).

He said most of the irregularities being discussed in the House related to the earlier Jeevandayee portal, while the new AI-based platform was capable of identifying anomalies, including instances where the same patient appeared to have undergone surgeries at multiple hospitals.

The minister named four hospitals against which action has already been initiated -- Shiv Multispeciality Hospital and Critical Care, Rishikesh Hospital, Magnum Multispeciality Hospital, and Sant Krupa Multispeciality and Accident Hospital -- and emphasised more healthcare facilities could come under scrutiny as the investigation progresses.

Abitkar insisted hospitals empanelled under the scheme are required to provide complete treatment and follow-up care and cannot demand money from beneficiaries for medical procedures covered under the health plan.

Patients who are asked to pay or denied treatment can file complaints online, with district coordinators or the state government, and every complaint will be investigated, he told the House.

Responding to concerns over officials remaining posted in the same district for years, the minister said district coordinators would be transferred wherever necessary, adding prolonged postings could encourage unhealthy practices.

He assured the House that action would be taken against any officials found complicit in irregularities.

During the discussion, BJP MLA Rahul Aher demanded a Special Investigation Team (SIT) and an Economic Offences Wing probe, alleging around 9,000 claims from 95 hospitals were linked to a single mobile number and questioning the scale of alleged fraud involving government funds.

Aher alleged that some district coordinators sought illegal favours from hospitals for empanelment under the scheme and demanded their transfer.

Abitkar assured legislators that all such allegations would be examined and strict action taken against anyone found guilty.