Ayushman Bharat embraces AI to tackle fraud

Ayushman Bharat embraces AI to tackle fraud

Subject : Scheme

Concept :

• An anti-fraud programme utilising artificial intelligence and machine learning has resulted in the recovery of Rs 9.5 crore in penalty money.
• The goal of this endeavour is to safeguard Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the biggest government-run insurance programme in the world.

Important Features

• The National Health Authority (NHA), the organization responsible for carrying out AB-PMJAY, released a thorough list of anti-fraud recommendations.
• For the purpose of overseeing the anti-fraud framework that is backed by State Anti-Fraud Units (SAFUs) at the State level, the National Anti-Fraud Unit (NAFU) was established at NHA.
• The Ayushman Bharat Digital Mission, which aims to establish a nationwide digital system to guarantee the security of personal health information, is now being implemented by the Ministry.

Ayushman Bharat Digital Mission

• It aims to provide digital health IDs for all Indian citizens to help hospitals, insurance firms, and citizens access health records electronically when required.
• The pilot project of the Mission had been announced by the Prime Minister from the ramparts of the Red Fort on 15th August 2020.
• The project is being implemented in the pilot phase in six States & Union Territories.

Features of the Mission:

• Health ID:
• It will be issued for every citizen that will also work as their health account. This health account will contain details of every test, every disease, the doctors visited, the medicines taken and the diagnosis.
• Health ID is free of cost, voluntary. It will help in doing analysis of health data and lead to better planning, budgeting and implementation for health programs.
• Healthcare Facilities & Professionals’ Registry:
• The other major component of the programme is creating a Healthcare Professionals’ Registry (HPR) and Healthcare Facilities Registry (HFR), allowing easy electronic access to medical professionals and health infrastructure.
• The HPR will be a comprehensive repository of all healthcare professionals involved in delivering healthcare services across both modern and traditional systems of medicine.
• The HFR database will have records of all the country’s health facilities.
• Ayushman Bharat Digital Mission Sandbox:
• The Sandbox, created as a part of the mission, will act as a framework for technology and product testing that will help organisations, including private players intending to be a part of the national digital health ecosystem become a Health Information Provider or Health Information User or efficiently link with building blocks of Ayushman Bharat Digital Mission.
• Implementing Agency:
• National Health Authority (NHA) under the Ministry of Health and Family Welfare.