11 June, 2025:
A massive scam involving fraudulent medical insurance claims worth Rs 10 crore has come to light across several private hospitals in Uttar Pradesh under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) and the Mukhyamantri Jan Arogya Yojana.
According to reports, the irregularities were detected during a routine audit, prompting the registration of an FIR at the Hazratganj police station. Authorities suspect a network of hospitals may have colluded to siphon off government funds by submitting fake treatment records and inflated bills. Further investigation is underway to determine the extent of the fraud and identify those involved.
The scam, allegedly carried out in collusion with several officials from a state agency, was reported by Dr. Brajesh Kumar Srivastava, the agency's Nodal Officer. He filed an FIR at the Hazratganj Police Station, bringing the multi-crore fraud to light.
According to the FIR, between May 1 and May 22, 2025, as many as 6,239 high-value insurance claims from 39 private hospitals were fraudulently approved and disbursed through the National Health Authority’s online portal. Notably, the approvals were made primarily during odd hours—late at night or outside regular working hours—raising red flags about their authenticity.
Preliminary investigations revealed that the login credentials of several senior officials, including those from the Implementation Support Agency (ISA), financial officers, and even the CEO of SACHIS, had been misused to process and approve the claims without proper authorization.
The UP government, while under public scrutiny, has promised to address the issue swiftly and ensure that all involved parties are held accountable. However, the incident highlights ongoing concerns regarding the management and oversight of health schemes intended to benefit the most vulnerable sections of society.
