MUMBAI: Five IT firms, including three prominent global players, will use data analytics to detect frauds and red-flag suspicious transactions in the Centre’s health insurance programme,Ayushman Bharat, that has catered to almost 5 lakh patients across India within 80 days of its launch.
At least 14 IT majors had been vying for the job since the scheme, touted as the world’s largest government-funded health initiative, was announced.
Currently, 60% of the 15,800 empanelled hospitals are from private sector. Dr.Indu Bhushan , CEO of Ayushman Bharat, told TOI on Wednesday that frauds can’t be entirely prevented, but they will not be tolerated. “It hampers sustainability, brings bad name and once that happens we also lose political support,” he said, underlining that data will be the scheme’s biggest armour. The scheme is expected to cater to 50 crore beneficiaries, which translates into that many patient files.
He said data analysis has already allowed them to spot unusual patterns such as 77 cataract surgeries being performed in one centre in a single day, or oddly male patients undergoing “hysterectomies”. “The hysterectomies turned out to be a coding error but it shows the potential of data,” Dr Bhushan said. He added that special teams have visited suspicious centres once they were red-flagged by the data team. Around 2% of cases will undergo medical audits.