The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) has recently witnessed significant challenges relating to malpractice, with over 550 private hospitals being suspended for fraudulent claims. Although penalties have been removed to encourage compliance, the establishment of a dedicated National Anti-Fraud Unit indicates a strong focus on governance, monitoring, and transparency. While these are essential for safeguarding financial sustainability, the issue also highlights the dependency on private hospitals under PMJAY for service delivery, particularly in rural and underserved regions. Over-reliance on private institutions, despite regulatory controls, risks perpetuating inequities if public health systems remain under-resourced.

A long-term sustainable solution lies in the capacity building of public hospitals, especially in villages and semi-urban areas, to reduce dependence on private providers. Strengthening district-level hospitals, primary health centers, and community health centers with modern infrastructure, trained manpower, and digital health integration can ensure equitable and reliable access. Investing in public health institutions also enhances cost-effectiveness and accountability while minimizing fraud vulnerability. Therefore, the scientific inquiry must assess whether robust anti-fraud monitoring alone will suffice, or if parallel investment in strengthening the public healthcare network is essential to achieve equity, efficiency, and universal health coverage goals under PMJAY.