MoHFW Launches AI-Powered Healthcare Claims Revolution Under Ayushman Bharat

According to Dr. Barnwal, robust and transparent claims adjudication is critical for building trust among empanelled hospitals, ensuring timely settlements and improving programme integrity under AB PM-JAY.

In a major step toward transforming India's public healthcare administration through artificial intelligence, the Ministry of Health and Family Welfare (MoHFW), in collaboration with the National Health Authority (NHA), IndiaAI Mission and the Indian Institute of Science (IISc), Bengaluru, inaugurated the AB PM-JAY Auto-Adjudication Hackathon Showcase 2026 — a national initiative aimed at deploying advanced AI technologies to modernise health claims management under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).

The two-day national event brought together policymakers, AI startups, healthcare technology firms, insurers, hospitals, Third Party Administrators (TPAs), researchers and academic institutions to demonstrate next-generation AI-powered solutions designed to improve efficiency, transparency and fraud detection within India's flagship public health insurance programme.

AI to Transform India's Healthcare Claims Ecosystem

Speaking at the inaugural session, National Health Authority CEO Dr. Sunil Kumar Barnwal described the initiative as a major opportunity to strengthen both healthcare delivery and operational efficiency under Ayushman Bharat through advanced digital technologies.

He emphasized that innovation is spread across institutions, academia, startups and industry, and said hackathons play an important role in bringing together distributed innovation to solve complex public healthcare challenges.

According to Dr. Barnwal, robust and transparent claims adjudication is critical for building trust among empanelled hospitals, ensuring timely settlements and improving programme integrity under AB PM-JAY.

"The vast and diverse data generated under AB PM-JAY offers immense potential for leveraging AI to further strengthen efficiency, transparency, and outcomes," he said.

India Positioning Itself as Global South Leader in Health AI

Dr. Barnwal also highlighted the National Health Authority's broader push to institutionalise AI in healthcare through initiatives such as BODH — an Open Benchmarking and Data Platform for Health AI, developed at IIT Kanpur and launched during the IndiaAI Impact Summit.

He noted that India is among the first countries in the Global South to establish such a benchmarking platform capable of validating AI systems using India-specific healthcare datasets as a digital public good.

The initiative reflects India's growing ambition to become a global leader in responsible, scalable and inclusive AI deployment in healthcare.

AI Systems Developed to Detect Medical Fraud and Deepfakes

One of the most significant highlights of the showcase was the demonstration of advanced AI and machine learning solutions developed under three major problem statements focused on strengthening claims adjudication and programme integrity under AB PM-JAY.

1. Clinical Document Classification and Treatment Guideline Compliance

Winning teams presented sophisticated AI systems capable of:

• Automated classification of healthcare documents

• Multilingual Optical Character Recognition (OCR)

• Extraction of structured clinical and billing data

• Confidence score generation

• Provenance tracking

• Detection of institutional stamps and authorised signatures

• Explainable adjudication outputs aligned with Standard Treatment Guidelines (STGs)

The systems were designed to process low-quality and heterogeneous medical scans while improving consistency and reducing manual verification burden.

AI Tools Can Now Analyse X-rays, CT Scans and MRIs

2. Radiological Image-Based Condition Detection

Another major innovation area involved AI-assisted interpretation of radiological images such as:

• X-rays

• CT scans

• MRI images

The showcased systems can help adjudicators correlate radiological findings with hospital-submitted clinical reports to verify:

• Claimed diagnoses

• Disease staging

• Treatment timelines

• Compliance with standard treatment protocols

Officials said such tools could significantly improve both speed and accuracy in healthcare claims processing.

Deepfake Detection Introduced into Healthcare Claims Management

3. Detection of Forged and Manipulated Medical Documents

Perhaps the most striking innovation area involved AI-driven systems designed to detect fraudulent medical documentation and deepfake manipulation.

Participating teams showcased technologies capable of identifying:

• Tampered discharge summaries

• Manipulated billing records

• Ghost beneficiaries

• Altered medical reports

• Synthetically generated healthcare documents

Officials believe such systems could dramatically strengthen programme integrity and reduce healthcare fraud under India's massive public insurance ecosystem.

High-Level Discussion on India's AI Healthcare Future

The event also featured a major policy panel discussion titled "Building AI for Indian Healthcare", chaired by MeitY Secretary Shri S. Krishnan.

The panel included representatives from:

• Government departments

• Healthcare technology companies

• Academic institutions

• AI ecosystem stakeholders

Discussions focused on practical pathways for scaling AI adoption in India's healthcare system, particularly in resource-constrained and multilingual environments.

Key themes included:

• Small Language Models (SLMs)

• Large Language Models (LLMs)

• Multimodal AI systems

• Workflow integration

• Privacy safeguards

• Validation frameworks

• Edge deployment

• Scalable healthcare AI infrastructure

Future-Ready Adjudication Framework for Ayushman Bharat

Officials said the AB PM-JAY Auto-Adjudication Hackathon is intended to drive the creation of AI-enabled systems that can seamlessly integrate into existing PM-JAY infrastructure while reducing manual workload and accelerating claims processing timelines.

The long-term goal is to establish a scalable and future-ready digital adjudication framework capable of handling the enormous healthcare data volumes generated under Ayushman Bharat — one of the world's largest public health insurance schemes.

India Expanding Digital Public Infrastructure into Healthcare

Experts say the initiative represents the next phase of India's broader digital public infrastructure strategy, which has already transformed sectors such as payments, identity verification and public service delivery.

By integrating AI into healthcare administration, India is attempting to build:

• Faster claims systems

• Fraud-resistant healthcare platforms

• Data-driven healthcare governance

• Scalable public health AI infrastructure

• Inclusive digital healthcare ecosystems

The National Health Authority said the initiative reaffirms its commitment to responsible AI deployment aimed at improving efficiency, transparency and trust within India's healthcare system.