Centre calls on IT firms to detect fraud in Ayushman insurance scheme: Report

September 14
14:57 2018

The central government has called on leading IT companies to develop a framework that will detect and send alerts for “suspicious” transactions in its ambitious PM Jan Arogya Yojana (PMJAY) health insurance scheme, reported The Economic Times. 

The government is planning to appoint partners for this project in the next four months after holding consultations starting this week, senior officials aware of the development told the paper, adding that firms such as IBM, L&T Technologies, Lexis-Nexis, IQVIA and Wipro have already expressed interest in designing such a framework.

The move comes after directions were issued from the highest quarters of the government that the scheme should have “zero tolerance” for fraud.

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Last month, the health ministry had released anti-fraud guidelines for states implementing PMJAY, known as Ayushman Bharat.

“Health insurance schemes/programmes are prone to fraud, abuse and leakages, which not only impact the programme financially but also often lead to endangerment of people’s health. Therefore, it is important to prevent, detect and deter fraud effectively through robust processes, trained manpower and timely action backed by state-of-the-art IT systems,” the Centre said in a proposal document, reviewed by the paper.

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During the consultations, the government look at the best practices, policies, procedures and IT solutions available across the globe to develop a robust fraud prevention, detection and control system for the scheme. The Centre’s flagship national health protection scheme will provide coverage to nearly 55 crore people and benefit 10.74 crore households.

“There are a lot of checks and balances already, but the government wants to have a software which can have triggers (when fraud is occurring) and is looking for agencies to help identify all those suspicious transactions. Many international companies that do this have shown interest,” a second official told the paper.

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After the consultations, the Centre will invite bids from companies to provide the service pan-India. The government may bring on board multiple partners based on the framework’s design, the official added.

While IBM, L&T Technologies, LexisNexis and Wipro did not respond to the paper’s query, US-based firm IQVIA said it could not comment on the development.

The Centre is reportedly preparing personalised cards, which need to be shown when treatment is sought in empanelled hospitals, for identified beneficiaries to make the scheme fraud-free. These cards are expected to be dispatched from this weekend to district headquarters, from where they will be distributed to the beneficiaries, an official told the paper.

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