Key Address: Naveen Jain, Secretary, Finance (Expenditure) Department, Rajasthan

In this video:
Key Address: Naveen Jain, Secretary, Finance (Expenditure) Department, Rajasthan

Topic: Auditing through AI & Analytics: A New Paradigm for Smarter Governance

Key Highlights:
[1] Rajasthan used AI, human instinct, and data analytics to audit 100% of OPD, IPD, and pharmacy claims under RGHS, detecting frauds like duplicate prescriptions, ghost patients, and inflated diagnoses.

[2] Custom “triggers” and “filters” such as flagging claims above certain cost thresholds helped identify suspicious cases without relying only on obvious red flags.

[3] RGHS is a fully cashless, insurance-free health scheme covering 15 lakh beneficiaries and 22 lakh family members, including OPD, pharmacy, and diagnostics—unlike any other state or central scheme.

[4] The scheme processes over 41,000 daily claims, making manual verification impossible and validating the critical role of technology in ensuring integrity.

[5] AI audits exposed scams involving fabricated prescriptions, non-existent doctor visits, and pharmacy claims for medicines that were never purchased or delivered.

[6] Technology can flag irregularities, but real impact comes when it’s combined with human judgment and administrative action on the ground.