Over 6k fake med claims made in 39 hospitals across UPunder Ayushman Bharat

Lucknow: An alleged scam of Rs 10 crore in fraudulent medical insurance claims under Ayushman Bharat and Mukhyamantri Jan Arogya schemes at several private hospitals of Uttar Pradesh has been busted. An FIR was registered at Hazratganj police station on Monday. BK Srivastava, the state nodal officer of the State Agency for Comprehensive Health and Integrated Services (SACHIS), filed the FIR alleging large-scale irregularities in the processing and approval of medical claims submitted by private hospitals empanelled under the two schemes.The FIR stated that between May 1 and May 22, 2025, a total of 6,239 claims from 39 private hospitals in UP were processed and paid through the centralised online system linked to the National Health Authority's digital portal. A routine audit raised concerns when an unusual volume of high-value claims was processed during odd hours, particularly late at night. Further analysis revealed that the login credentials of key officials, including Implementation Support Agency (ISA) staff, financial officers, and the CEO of SACHIS, were misused to approve these claims without proper scrutiny or authorisation.The fraudulent activity involved unauthorised access and digital manipulation of login IDs such as UP003507, UP008126, UP008171, UP008038, UP008039 (ISA users), UP001730, UP003881 (Finance/Accounts), and UP008296 (CEO-SACHIS). Srivastava said these IDs were used to process claims without any online recommendation from the actual users. ISA officials denied any involvement, saying that none of the disputed claims were routed or approved through their system.ACP Hazratganj Vikas Jaiswal said the FIR stated that the timestamps of the transactions indicated deliberate manipulation, as several claims were processed outside normal office hours, suggesting either an insider conspiracy or a highly sophisticated cyber breach.Under Ayushman Bharat scheme SOPs, hospital claims are first submitted on the portal after a beneficiary is treated. These claims are vetted by the ISA, medically audited, and financially verified at SACHIS before being forwarded to the CEO for final approval and payment via banks. However, the scam bypassed this entire chain of checks. The scam came to light when office-level reviews found disproportionate payments being made from the finance manager's login, which was not used by the designated officer at the time of the approvals. Investigations revealed that the login IDs were hacked or misused to clear claims for hospitals not eligible for such reimbursements or had exaggerated treatment data. Irregularities were noticed when payments appeared inflated compared to volume of patients reportedly treated under the scheme. Following internal review and verification from the ISA, it became evident that the online recommendations for claim settlements did not come from the actual users, suggesting a systemic breach.Further audits may reveal a larger figure. Sources said govt has formed an inquiry committee to assess internal lapses within SACHIS.