Maharashtra to Use AI to Detect Health Insurance Fraud and Target Illegal IVF Centres
On Wednesday, Maharashtra Health Minister Prakash Abitkar announced a strict crackdown in Mumbai against fraud in the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) health insurance scheme and illegal IVF and sonography centres. Speaking in the Legislative Assembly, Abitkar stated that the government will deploy a new artificial intelligence-enabled portal, KMS 2.0, alongside flying squads and real-time dashboards to identify and prevent irregularities.
The state upgraded its health insurance management system by replacing the older Jeevandayee portal with the KMS 2.0 platform. According to Abitkar, the new AI-enabled system has already flagged suspicious insurance claims and treatment patterns, prompting the health department to initiate action. The minister emphasized that anyone found guilty of malpractice will face strict action.
The AI-based monitoring system is designed to track implementation, improve transparency, and identify anomalies, such as cases where a single patient is shown to have undergone surgeries at multiple hospitals. Abitkar noted that most of the irregularities discussed in the Assembly had occurred under the previous Jeevandayee portal.
Under the MJPJAY scheme, empanelled hospitals are strictly prohibited from charging beneficiaries for covered procedures. Abitkar reiterated that patients who are denied cashless treatment or asked to make payments can register their complaints online, through district coordinators, or directly with the state government. Every registered complaint will be investigated.
In addition to the insurance crackdown, the government will establish a Special Task Force (STF) to conduct a statewide drive against unauthorized IVF and sonography centres. Responding to a question from Samajwadi Party MLA Abu Azmi, Abitkar said the STF will inspect facilities across Maharashtra to shut down illegal centres operating without mandatory approvals.
The minister also revealed that the state government is considering bringing these offences under the purview of organized crime laws. A bill to establish a stronger legal framework against unauthorized medical centres is expected to be introduced during the next session of the state legislature.
