Maharashtra Probes 15,000 Fraudulent Healthcare Claims: SIT Formed to Uncover Multi-District Scam

Mumbai, August 5: The Government of Maharashtra has constituted a high-level Special Investigation Team (SIT) to probe 15,407 suspicious medical claims flagged under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY). The alleged irregularities span the period between 2024 and 2026, pointing toward a widespread, multi-district network of fraudulent healthcare reimbursements.

Given the scale and geographical spread of the alleged malpractice across multiple districts, the state government has appointed Dr. Pravin Gedam, Divisional Commissioner of Nashik, to lead the multi-agency task force. The panel brings together senior leaders and law enforcement officials, including Public Health Department Secretary-2 E. Ravendiran, IT and Artificial Intelligence Department Secretary Virendra Singh, a Police Inspector from the Nashik Cyber Police Station, an Assistant Commissioner of Police from the Economic Offences Wing (EOW) in Nashik, and the Deputy Secretary of the Public Health Department. Medical experts from the Medical Education and Drugs Department will also be consulted to evaluate clinical validity and hospital procedures throughout the inquiry.

The investigation targets systemic vulnerabilities, artificial claim inflation, and organized fraud within empanelled healthcare facilities. Key operational focus areas include fake and medically unnecessary claims, unwarranted upcoding to secure higher state reimbursements, irregularities in hospital empanelment, and the unauthorized involvement of brokers registering patients using duplicate contact details or identification documents. Furthermore, the SIT will investigate potential insider collusion among District Coordinators, Third-Party Agencies (TPAs), and administrative personnel, while formulating structural recommendations to harden claim-approval processes against future exploitation.

The SIT has been directed to complete its comprehensive inquiry and submit a final report to the state government within 30 days. Operational expenses, technical infrastructure, and administrative support will be funded through the State Health Assurance Society. This decisive regulatory intervention is expected to curtail systemic corruption, safeguard public healthcare funds, and restore transparent access for legitimate beneficiaries across Maharashtra.