All 1,242 private hospitals in Uttar Pradesh participating in the Ayushman Bharat scheme are now granted access to a ‘green payment channel.’ Under this arrangement, these hospitals will receive 50% of their claim amount promptly upon bill submission. However, stringent monitoring will be in place to detect any irregularities, with corresponding actions taken against any defaults.
Sangeeta Singh, CEO of SACHIS, the agency responsible for overseeing the Ayushman Bharat scheme’s implementation in the state, explained that the green channel includes the use of artificial intelligence to scrutinize billing accuracy. Numerous parameters have been integrated into the system to employ artificial intelligence and flag any discrepancies, marking them as red for further review.
Dr. Abhishek Shukla, Secretary-General of the Association of International Doctors, elaborated on the advantages of the green payment channel: “Hospitals initially bear the cost of implants, medicines, and consumables. By receiving 50% of the payment promptly from the Ayushman Bharat scheme, this amount can be reinvested in treating more patients.”
Nonetheless, artificial intelligence will closely monitor various aspects. For instance, it will flag cases where two bills share the same patient’s name within a short time frame or if a hospital submits different bill amounts for similar treatments.
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Once identified by the artificial intelligence system, such cases will be referred to the national anti-fraud unit of the national health authority. After a thorough examination, the matter will be handed over to the respective state for resolution.
SAFU will carefully review bills and treatment records
At the state level, the State Anti-Fraud Unit (SAFU) will carefully review bills and treatment records.
Sangeeta Singh emphasized, “In many instances, bills that may appear fraudulent are actually legitimate. This can occur when an individual falls ill again shortly after being discharged from the hospital or for other valid reasons. Our expert panel, consisting of doctors, will scrutinize such cases, and if they are found to be genuine, the bills will be approved.”