3 weeks ago
Maharashtra Forms SIT to Probe 15,407 Suspicious Health Insurance Claims
Some people in Maharashtra may have cheated the government's health insurance programs by making claims for medical treatment that was not real or not needed.
The government checked health insurance claims and found 15,407 that looked suspicious.
These claims were made under two schemes that help poor families pay for hospital care of up to Rs 5 lakh a year.
To figure out what happened, the government created a special team called the SIT.
The SIT is led by an important government officer named Pravin Gedam.
The team will look at hospitals that may have made fake claims or charged too much money.
It will also check if people used the same phone number or identity proof to register many patients.
The SIT has to finish its investigation and give a report within 30 days.
The goal is to stop cheating and make the insurance plans work fairly for the people who really need them.
Maharashtra detected 15,407 suspicious health insurance claims under Ayushman Bharat-PMJAY and Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) during preliminary scrutiny.
The state government has constituted a Special Investigation Team (SIT) headed by Nashik Divisional Commissioner Dr Pravin Gedam.
The suspected irregularities pertain to claims made between 2024 and 2026, according to a Government Resolution issued on August 5.
The probe covers fake or medically unnecessary treatments, inflated packages, empanelment violations, middlemen, and multiple claims linked to the same mobile number or identity proof.
The SIT must submit its report within 30 days, with manpower and technical assistance from the State Health Assurance Society.
- Who
- The Maharashtra state government and a Special Investigation Team headed by Nashik Divisional Commissioner Dr Pravin Gedam, following a review chaired by Chief Minister Devendra Fadnavis.
- What
- Detection of 15,407 suspicious health insurance claims and a probe into alleged fraud under the Ayushman Bharat-PMJAY and MJPJAY schemes.
- Where
- Maharashtra, India.
- When
- Government Resolution issued on August 5; claims pertain to 2024-2026; report due within 30 days of the SIT's formation.
- Why
- Alleged fraud spanning multiple districts, including fake claims, inflated treatment procedures, empanelment irregularities, and registration irregularities.
Key facts
- Suspicious claims detected
- 15,407
- Schemes involved
- Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY)
- Claims period
- 2024-2026
- Government Resolution date
- August 5
- SIT head
- Nashik Divisional Commissioner Dr Pravin Gedam
- Report deadline
- Within 30 days of SIT formation
- Coverage
- Up to Rs 5 lakh per family per year under both schemes
- Review meeting
- July 10, chaired by Chief Minister Devendra Fadnavis









