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Mumbai, November 21, 2025: Medi Assist Healthcare Services Limited (“Medi Assist” or the “Company”), India’s largest technology-led health benefits administrator, today announced new AI-driven platforms that advance its vision of delivering Sustainable Benefits and Effortless Experience. These platforms are designed to make member interactions seamless while strengthening transparency, integrity, and long-term sustainability across the health benefits value chain.
Over the past year, Medi Assist has accelerated its mission to make cashless healthcare truly seamless. Key outcomes include:
- 15% of all discharges- over 4,00,000 members- now leaving the hospital before the final bill is generated.
- 25% of its provider network (4,000+ hospitals) enabled next-generation cashless workflows.
- 70% of total claim value now processed on cashless.
- 85% of cashless claims digitally submitted, improving speed and reducing friction for all stakeholders.
To further strengthen service delivery, Medi Assist announced two AI-powered platforms:
- MAven Guard: a self-learning transaction integrity platform to detect, prevent, and deter fraud, waste, and abuse in real time.
- MAgnum: a hospital enablement solution designed to let providers make cashless experience effortless for the members.
Both solutions are built on Medi Assist’s comprehensive AI Stack, enabling the Company’s long-term ambition of making benefits sustainable and member experience effortless.
Alongside the platform launches, Medi Assist and Boston Consulting Group (BCG) released a new report: “From Suspicion to Solution: A Strategic Approach to Health Insurance Fraud.”
Key findings from the Raksha Report:
- ₹8,000–10,000 crore in annual claim payouts leak due to Fraud, Waste, and Abuse (FWA).
- FWA inflates premiums, weakens insurer margins, and strains public resources.
- Systemic issues- fragmented data, weak controls, misaligned incentives, fuel predictable leakage patterns and rising out-of-pocket expenditure.
The report recommends a three-pillar framework of Prevention, Detection, and Deterrence, supported by:
- A unified national codebook,
- Governed GenAI and digital intelligence,
- Real-time data exchange through ABDM and NHCX.
These measures form a foundational roadmap toward the Government’s Viksit Bharat 2047 vision of “Insurance for All.”
Satish Gidugu, CEO, Medi Assist said, “As India’s health system stands at an inflection point, the next decade will be defined by connected data and intelligent automation. At the heart of this transformation, both technology and AI are enabling insurers to proactively identify and reduce Fraud, Waste, and Abuse (FWA); translating into direct cost savings and improved operational efficiencies. Each year, an estimated ₹8,000–10,000 crore of claim payouts leak through FWA, which erode insurer margins, inflate customer premiums, and strain public resources. Therefore, the need of the hour is to ensure that we forge digital trust and transparency into our health insurance infrastructure, thereby ensuring that care remains accessible, affordable, and accountable for all citizens.”
Swayamjit Mishra, Managing Director and Partner, Core Member Financial Services and Technology Lead in Insurance, APAC, BCG said, “In India’s health insurance landscape, about 90% of claims are risk-free, while 2% are outright fraudulent and continue to be flagged today. The real opportunity lies in the remaining 8%, where inefficiencies and abuse can be addressed without inconveniencing genuine policyholders. Harnessing digital intelligence, interoperable platforms, and next-generation technology, we can systematically target this segment to reduce fraud leakage, improve trust, and unlock significant value across the ecosystem. These efforts can advance the government’s Insurance for All vision by nearly five years, strengthening India’s journey toward a transparent, technology-driven, and sustainable health insurance system”
This initiative marks an important step in building a more accessible, efficient, and trusted health benefits ecosystem for India.
