Maharashtra SIT to probe 15,407 suspicious Ayushman Bharat, MJPJAY claims
Synopsis
Maharashtra has launched a multi-agency SIT to investigate 15,407 suspicious insurance claims under two flagship health schemes — a scale of alleged fraud that spans multiple districts and implicates hospitals, third-party administrators, and patient registration systems. With a 30-day deadline and criminal action on the table, this is the state's most sweeping crackdown yet on public health scheme misuse.
Key Takeaways
Maharashtra constituted an SIT on 5 August to probe 15,407 suspicious claims under AB-PMJAY and MJPJAY filed between 2024 and 2026 .
The SIT is chaired by Nashik Divisional Commissioner Pravin Gedam and includes officials from Cyber Police, EOW, and the Health Department.
The team must submit its report within 30 days ; legal and administrative action will follow based on findings.
Alleged irregularities include fake claims, upcoding, suspicious patient registrations, and multiple claims under a single identity.
Health Minister Prakash Abitkar warned hospitals against overcharging, threatening immediate delisting and FIRs .
A real-time bed tracking dashboard has been announced to stop private hospitals from denying beds to scheme beneficiaries.
The Maharashtra government on Wednesday, 5 August constituted a Special Investigation Team (SIT) to investigate 15,407 suspicious medical treatment claims filed between 2024 and 2026 under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY). A formal Government Resolution was issued the same day, following directives from a meeting chaired by Chief Minister Devendra Fadnavis on 10 July.
SIT Composition and Mandate
The SIT has been constituted under the chairmanship of Nashik Divisional Commissioner Pravin Gedam and draws members from the Public Health Department, Information Technology Department, Cyber Police, Economic Offences Wing (EOW), and the Health Department. Expert doctors from the Medical Education Department will provide technical support as required.
The team has been given a strict 30-day deadline to complete its inquiry and submit a report to the state government. Further legal and administrative action against those found culpable will be determined on the basis of the SIT's findings.
Key Areas Under Investigation
The SIT's scope is wide-ranging. It will examine alleged instances of fake or medically unnecessary treatment claims at the hospital level, unwarranted upcoding of treatment categories, irregularities in hospital empanelment and renewal processes, suspicious patient registrations, and multiple claims filed under a single mobile number or identity document. The potential role of Third-Party Administrators, district coordinators, and other intermediaries is also under scrutiny.
Initial field investigations by Civil Surgeons and District Health Officers — who were directed to physically verify suspicious claims — revealed that alleged irregularities span multiple districts, prompting the state to escalate to an independent SIT-led probe.
What the Government Said
State Public Health Minister Prakash Abitkar told the State Legislature during the Monsoon session that treatment under MJPJAY and Ayushman Bharat of up to ₹5 lakh is intended to be entirely free and cashless for beneficiaries. He warned that hospitals found charging patients even a single rupee beyond the scheme will face immediate delisting and criminal action, including the filing of First Information Reports (FIRs).
Notably, the Health Department also announced a real-time bed tracking dashboard to prevent private hospitals from falsely claiming non-availability of beds for scheme beneficiaries — a practice that has reportedly been used to turn away entitled patients.
What Happens Next
The SIT is also tasked with identifying systemic flaws in the claim approval process, monitoring mechanisms, and hospital empanelment procedures, with a mandate to recommend structural reforms. The outcome of the inquiry is expected to shape policy corrections across both schemes, which together cover millions of low-income beneficiaries across Maharashtra.
Point of View
407 suspicious claims across multiple districts over just two years — points to systemic failure, not isolated misconduct. The involvement of third-party administrators and upcoding patterns suggests the exploitation was structured, not opportunistic. Maharashtra's SIT is a necessary step, but a 30-day deadline for an inquiry of this complexity risks producing a superficial report that names small actors while leaving institutional enablers untouched. The real test will be whether the recommended reforms — on empanelment, claim approval, and real-time monitoring — are actually implemented, or whether this becomes another inquiry whose findings gather dust.
NationPress
6 Aug 2026
Frequently Asked Questions
Why has Maharashtra formed an SIT to probe Ayushman Bharat and MJPJAY claims?
The Maharashtra government formed the SIT after initial investigations by Civil Surgeons and District Health Officers identified 15,407 suspicious medical treatment claims filed between 2024 and 2026 under AB-PMJAY and MJPJAY. Because the alleged irregularities span multiple districts, the state escalated to an independent SIT-led probe for a comprehensive investigation.
Who is heading the Maharashtra health scheme fraud SIT?
The SIT is chaired by Nashik Divisional Commissioner Pravin Gedam. It includes senior officials from the Public Health Department, Information Technology Department, Cyber Police, Economic Offences Wing, and the Health Department, with expert doctors from the Medical Education Department providing technical support.
What types of fraud is the SIT investigating?
The SIT is examining fake or medically unnecessary treatment claims, unwarranted upcoding of treatment categories, irregularities in hospital empanelment, suspicious patient registrations, and multiple claims filed under a single mobile number or identity card. The role of Third-Party Administrators and district coordinators is also under scrutiny.
What action can hospitals face if found guilty?
Hospitals found overcharging scheme beneficiaries or filing fraudulent claims face immediate delisting from the schemes and criminal action, including the registration of First Information Reports (FIRs), according to Health Minister Prakash Abitkar.
When will the SIT submit its findings?
The SIT has been directed to complete its investigation and submit its report to the Maharashtra government within 30 days of its constitution on 5 August. Further legal and administrative action will be determined based on those findings.
