Catch the fraud BPA scrutiny doesn’t.
Pratyaksh sits over the existing ECHS pipeline — the 64 KB smart card, the UTI-ITSL Bill Processing Agency, the polyclinic referral stream — and adds three things ECHS does not have today: an emergency-admission auto-trigger, a cross-hospital nexus graph that sees collusion with non-empanelled entities, and a one-way bedside witness call by a verified Army Medical Corps officer.
- ₹105 Cr+
- ECHS losses flagged in CAG performance audit (Report 51 of 2015)
- ₹562.4 Cr
- fake AB-PMJAY claims detected by NHA — proof active surveillance works
- 2025
- CBI books super-specialty hospitals in Chandigarh-Mohali ECHS fraud
Public-record figures from CAG, NHA and CBI. Full source list in footer.
Evidence bundle hash-chained · ready for Channel of Inquiry
The same fraud patterns CAG flagged in 2015 are the ones CBI is booking in 2025.
ECHS already has identity (64 KB smart card with Aadhaar biometric), claims processing (UTI-ITSL BPA), and patient telemedicine (E-SeHAT). What it does not have is a layer that watches patterns across claims and intervenes before money moves.
CAG 2025 named “poor scrutiny of emergency admissions.” The 2025 CBI Chandigarh-Mohali case used exactly this loophole — emergency tags to bypass referral, then inflated bills.
CAG 2015 cited ₹42.67 lakh raised by two empanelled hospitals for the same patient on the same day, in two cities. BPA scrutinises per-claim, not cross-claim. The gap is still open.
Manthan Health Care (Chandigarh, 2025), not ECHS-empanelled, allegedly operated as a back-end for empanelled hospitals — invisible to the 64 KB smart card and BPA portal.
Every ECHS inquiry today starts with a complaint. The Aug 2025 DESW order centralised every punitive action — slower, not earlier. There is no proactive trigger from the claim itself.
What Pratyaksh does — and only what is genuinely missing.
We dropped every module that duplicates a deployed ECHS, CGHS or NHA system. What remains is the four real gaps audit reports keep surfacing: emergency triggers, cross-hospital nexus, bedside witness, and a pre-disbursement hold.
What Pratyaksh is not — and exactly how it plugs in.
Pratyaksh is additive infrastructure. It does not replace any deployed ECHS, CGHS or NHA system; it consumes their feeds and feeds back into their workflows.
We do not replace
- ECHS 64 KB Smart CardSource Infosys · Beneficiary identity · Aadhaar biometric at admission
- Bill Processing AgencyUTI-ITSL · echsbpa.utiitsl.com · Claims submission, scrutiny, reimbursement
- E-SeHAT / SeHAT OPDHQ IDS · DGAFMS · CDAC Mohali · Doctor-to-patient telemedicine consultation
- NABH empanelmentNABH · ECHS · Empanelment certification and inspection
- CGHS HMIS (2025)C-DAC · CGHS beneficiary management & PAN-link
We integrate at these seams
- Inbound · BPA claim feedReal-time webhook (or N-min pull) of submitted claims with line items, emergency flag and supporting docs.
- Inbound · Smart-card transaction eventsCard auth events (card #, hospital ID, timestamp, biometric pass/fail) for cross-hospital collision detection.
- Inbound · Polyclinic referral recordsReferring physician, beneficiary, target hospital and specialty — the spine of the nexus graph.
- Outbound · Pre-disbursement hold to BPAHold notice with reason code and evidence-pack URL. BPA holds payout pending Channel of Inquiry decision.
- Outbound · Vigilance trigger to Director (C&L)Hash-chained case file routed into the existing ECHS Channel of Inquiry — does not bypass DESW approval.
- Outbound · Forensic export (CAG / CBI)Signed, append-only evidence bundle with public hash root for independent verification.
Full integration spec: docs/integration-surface.md.
Five steps. Each one is additive — none removes an existing control.
- 01BPA receives claim
Empanelled hospital submits to UTI-ITSL BPA as today. No change to hospital workflow.
- 02Pratyaksh scores
We consume the BPA feed in real time, run rule triggers (emergency, duplicate, rate-card outlier) and score against the nexus graph.
- 03Trigger or release
Score below threshold → BPA proceeds untouched. Score above → page an AMC officer and place a pre-disbursement hold.
- 04Bedside witness
Officer joins on one-way visual to the bedside, confirms patient and procedure, signs the observation cryptographically.
- 05Channel of Inquiry
Confirmed cases route into the existing ECHS Channel of Inquiry with a complete hash-chained evidence pack. DESW retains approval authority.
Sized against public-record audits, not invented pilots.
We have not run a pilot yet. The numbers below come from published CAG reports and the National Health Authority’s own disclosures on AB-PMJAY, which is the closest comparable scheme with active surveillance already deployed.
First-of-its-kind performance audit, Report 51 of 2015 — three-year window.
NHA disclosure · 2.7 lakh claims, 1,114 hospitals de-empanelled, 549 suspended.
No rip-and-replace. We consume BPA / smart-card feeds and feed back into Channel of Inquiry.
Pricing tied to confirmed pre-disbursement holds adjudicated through DESW. No upfront capex proposed.
Built to feed evidence into the chain that already exists.
Run Pratyaksh against a live BPA queue — without touching payouts.
A 90-day shadow-mode pilot consumes the BPA feed read-only and surfaces what Pratyaksh would have flagged. No holds are placed, no referrals stopped. At day 90 we co-publish the precision/recall numbers with the empanelling authority, and only then discuss enabling pre-disbursement holds.
Briefings available to ECHS Central Organisation, DESW, CGHS DG and NHA. We are not asking for production access on day one.