Government Initiates AI and ML Solutions to Prevent Healthcare Fraud under PM-JAY
In a bid to curb healthcare fraud and ensure that eligible beneficiaries receive the necessary treatment, the Government of India has turned to Artificial Intelligence (AI) and Machine Learning (ML). These advanced technologies are being employed as part of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), a significant publicly sponsored healthcare program introduced by Prime Minister Narendra Modi on September 23, 2018.
The primary objective of PM-JAY is to provide accessible and high-quality hospital care to all residents of India, particularly those who are underserved and vulnerable, without causing financial hardship. Under this program, eligible families are entitled to medical coverage of up to Rs 5 lakhs per year for secondary and tertiary care hospitalization across both public and private empanelled hospitals in the country.
To ensure the smooth operation of PM-JAY, the government is leveraging the power of AI and ML. These cutting-edge technologies enable the detection, prevention, and deterrence of healthcare fraud. By implementing AI and ML algorithms, authorities can identify suspicious activities, patterns, and anomalies in healthcare claims, ultimately safeguarding the integrity of the program and ensuring that resources are directed toward those in need.
Since its launch, PM-JAY has made substantial progress. As of August 1, 2023, a staggering 24.33 crore Ayushman cards, which serve as the key to accessing benefits under the program, have been issued. This indicates the widespread impact and significance of PM-JAY in providing healthcare coverage to millions of individuals and families across the nation.
Under PM-JAY, beneficiaries can avail cashless treatment at any empanelled public or private hospital in India. The program covers a wide range of medical services, including 1,929 procedures encompassing expenses related to medication, diagnostics, doctor’s fees, room charges, and more. Furthermore, all pre-existing conditions are covered from the very first day of enrollment, eliminating any barriers to accessing essential healthcare.
Beneficiaries of PM-JAY are identified based on specific criteria. For rural areas, deprivation categories (D1, D2, D3, D4, D5, and D7) outlined in the Socio-Economic Caste Census database are utilized, while urban areas employ 11 occupational criteria. Additionally, individuals already benefiting from the RSBY program, where applicable, are also included.
The healthcare landscape in India is evolving with the integration of AI and ML in government welfare initiatives like PM-JAY. By leveraging these innovative technologies, the government is taking proactive measures to combat healthcare fraud, ensuring that funds are directed towards those who genuinely need assistance.
In conclusion, the Government of India’s implementation of AI and ML solutions under PM-JAY marks a significant stride in securing the healthcare system and promoting equitable access to treatment. The convergence of technology and public welfare programs demonstrates a commitment to leveraging advancements for the greater good and fostering a healthier nation.
