Medi Assist has unveiled a suite of AI-powered platforms designed to advance its commitment to creating a more sustainable and efficient health benefits ecosystem. The new platforms are set to enhance member experience, increase transparency, and support long-term sustainability across the health benefits value chain. The announcement follows a year of significant progress for Medi Assist, which has accelerated efforts to improve the cashless healthcare process. Notably, over 400,000 members (15% of all hospital discharges) are now leaving hospitals before the final bill is generated, while 70% of total claims are processed on a cashless basis. Additionally, 85% of cashless claims are digitally submitted, streamlining processes for all stakeholders.
To further strengthen service delivery, Medi Assist has introduced two AI-driven solutions. The first, MAven Guard, is a self-learning platform that ensures transaction integrity by detecting, preventing, and mitigating fraud, waste, and abuse (FWA) in real-time. The second, MAgnum, is a hospital enablement solution that aims to optimise the cashless experience for healthcare providers and their patients. Both solutions are powered by Medi Assist’s comprehensive AI stack, which aligns with the Company’s broader ambition of delivering sustainable health benefits and a seamless member experience.
In conjunction with these platform launches, Medi Assist has partnered with Boston Consulting Group (BCG) to release a new report titled “From Suspicion to Solution: A Strategic Approach to Health Insurance Fraud”. The report highlights several critical findings related to FWA in India’s health insurance sector, including the estimated annual loss of ₹8,000–10,000 crore due to fraudulent activities. These losses, the report states, inflate insurance premiums, undermine insurer margins, and strain public health resources. It also points out that systemic challenges such as fragmented data, inadequate controls, and misaligned incentives contribute to predictable leakage patterns and rising out-of-pocket costs for policyholders. The report proposes a three-pronged framework for addressing these issues: Prevention, Detection, and Deterrence, and advocates for measures such as a unified national codebook, governance of Generative AI and digital intelligence, and real-time data exchange through platforms like the Ayushman Bharat Digital Mission (ABDM) and the National Health Claims Exchange (NHCX).
Satish Gidugu, CEO of Medi Assist, commented: “India’s health system stands at a critical juncture, with the next decade set to be defined by connected data and intelligent automation. Technology and AI are pivotal in proactively tackling fraud, waste, and abuse, which currently account for significant losses each year. By embedding digital trust and transparency into the health insurance infrastructure, we can ensure that healthcare remains accessible, affordable, and accountable for all citizens.” Swayamjit Mishra, Managing Director and Partner at BCG, added: “While 90% of claims in India’s health insurance landscape are legitimate, there is an opportunity to address inefficiencies and abuse within the remaining 8% without inconveniencing genuine policyholders. By harnessing digital intelligence and interoperable platforms, we can reduce fraud leakage, improve trust, and unlock value across the ecosystem. These efforts will advance the government’s ‘Insurance for All’ vision by nearly five years, contributing to a more transparent, technology-driven, and sustainable health insurance system.”
This initiative marks an important step towards building a more accessible, efficient, and trusted health benefits ecosystem in India, supporting the country’s broader ambitions for health system reform.