Maharashtra forms SIT to probe 15,400 suspicious health insurance claims
The Maharashtra government has constituted a Special Investigation Team (SIT) after detecting 15,407 suspicious health insurance claims under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY), according to a government resolution issued on Wednesday, Aug 6th.
The suspected irregularities relate to claims made between 2024 and 2026.
The government had earlier directed district civil surgeons and district health officers to physically verify beneficiaries in all 15,407 cases. Following a review meeting chaired by Chief Minister Devendra Fadnavis on July 10, it decided to order a wider investigation after the alleged fraud appeared to span multiple districts.
Nashik Divisional Commissioner Pravin Gedam will head the SIT. The deputy secretary in charge of MJPJAY in the Public Health Department will serve as member secretary, while the Medical Education Department will provide specialist doctors whenever required.
The SIT will investigate fake or medically unnecessary claims, inflated treatment procedures, irregularities in hospital empanelment and renewals, the use of unauthorised persons or middlemen during patient registration, multiple registrations linked to the same mobile number or identity proof, and the possible involvement of district coordinators, third-party agencies and other stakeholders.
It has also been tasked with identifying gaps in the empanelment, claim approval and monitoring processes under the two schemes and recommending measures to strengthen oversight.
The SIT has been asked to submit its report within 30 days. The State Health Assurance Society will provide manpower and technical support, while the investigation's operational expenses will be met from its administrative budget.
