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.

Five players in the data and analytics field have been shortlisted to detect frauds in the Pradhan Mantri Jan Arogya Yojana (PMJAY), popularly known as Ayushman Bharat. The companies — LexisNexis, Optum, Greenojo, MFX and SAS — will compete to detect malpractice by hospitals part of the scheme for six months. The best performer among the five will be taken on board as Ayushman Bharat’s official fraud and abuse detection firm.

Dr. Indu Bhushan, CEO of Ayushman Bharat, said, “These are major companies and among the best in the world. They have a lot of experience in detecting frauds and abuse of such schemes. For the first six months, the firms will be working free of cost. Once the best company is taken on board, their team will get outcome-based payment depending on the fraud they have detected.” Dr. Bhushan was speaking at Sankalp Global Summit in Goregaon on Wednesday.

Nearly 60% of procedures under Ayushman Bharat is being carried out in the private sector. At a time when the focus should be on strengthening public hospitals by improving infrastructure and getting better services, the ambitious government scheme has been criticised for directing public money into the private sector. There have also been many reports of a spurt in certain procedures in private hospitals, patients being charged for surgeries.

Dr. Bhushan said, “We have been carrying out selective audits. Packages that are prone to frauds have been restricted to public sector hospitals. For example, mental healthcare is restricted to public hospitals. There are certain procedures that require pre-authorisation from the States. We follow up with patients randomly to keep a check as well.”

Infosys founder N. Narayan Murthy on Tuesday said that every enterprise has to first master the art of selling, at the 10th Sankalp Global Summit, an initiative by Intellecap at NESCO in Goregaon.

Addressing budding entrepreneurs and discussing the theme of ‘Agenda 3 Billion: Building Entrepreneurial Ecosystems,’ Mr. Murthy said, “It is the most important aspect of any kind of entrepreneurship, second is finance. Obtain better returns for your investors. Then you need a team with various strengths, technology and lastly, without luck, it is very difficult to succeed.”

The Infosys founder said that the what India needs is cultural transformation through honesty and discipline.

Speaking on the occassion, Niti Aayog CEO, Amitabh Kant said that in India, we have travelled the journey of opening a bank account in 10 months to now to 55 seconds using biometrics, when we use instruments like Aadhar.

“The process of urbanisation provides unlimited opportunities to entrepreneurs in India and across the world to use technology and innovation to tackle our immense challenges,” Mr. Kant said.