Indian AI healthcare revamp: 5 insights from Medi Assist and BCG report

Somewhere between the fluorescent hallways of corporate hospitals and the labyrinth of insurance paperwork, India’s healthcare system quietly crossed a milestone this year – and most of us missed it. I certainly would have, had I not walked into Raksha Summit in November 2025 and felt an odd sense of deja vu.

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Back in February, I had interviewed Medi Assist’s Satish Gidugu and Dhruv Rastogi – a conversation that began with fax machines and ended with AI models crunching 160 parameters to sniff out fraud. That story wasn’t meant to be a standalone snapshot. It was a breadcrumb on a much longer trail, one that’s now entering a significantly more ambitious chapter.

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At Raksha Summit 2025, Medi Assist didn’t just present random updates; to me it felt like it rolled out a full-blown AI strategy that feels less like incremental progress and more like a line in the sand. Together with Boston Consulting Group (BCG), they’re making the case – with data, urgency, and a surprisingly clear blueprint – for what India’s AI-enabled healthcare future must look like.

If you want to understand the slow but steady shift beneath India’s healthcare benefits ecosystem, here are the five takeaways that matter most.

1. Cashless is becoming the default of mediclaim in India

A year ago, Medi Assist was dabbling in predictive discharge tools. Today, according to Medi Assist, as much as 15% of all hospital discharges – over 4,00,000 members – walk out before the final bill is even generated. It’s a workflow revolution that goes beyond just convenience to becoming the new norm.

Seventy percent of all claim value now moves through cashless. And 85% of those cashless claims are digitally submitted – a frictionless loop that once felt unimaginable in a sector infamous for paper trails and opaque approvals.

This isn’t digitisation for the sake of it, according to Medi Assist, but a systemic re-engineering of time. And in healthcare, time is many things – and most importantly dignity where it matters most.

2. Fraud, waste, and abuse (FWA) in Indian healthcare

The new BCG–Medi Assist report puts a number on what insiders have whispered for years:
₹8,000–10,000 crore is siphoned off annually through suspicious patterns, inflated bills, unnecessary procedures, and flat-out fraud.

But here’s the crazy part of the report, that only 2% of claims are outright fraudulent. The real problem to solve is the murky 8% zone – where inefficiencies and abuse hide in plain sight. That’s where AI steps in, not as a detective but as a spotlight.

3. Medi Assist’s new AI stack: MAven Guard and MAgnum

If my February interview was Act I of Medi Assist’s tech story, Raksha Summit 2025 was Act II – bigger cast, deeper plot, and much sharper tools.

• MAven Guard is a self-learning integrity engine that detects, prevents, and deters fraud, waste and abuse (FWA) in real-time. Think of it as an AI-powered lie detector for the health ecosystem, processing patterns no human auditor could spot in a lifetime.
  
• MAgnum empowers hospitals to make the cashless experience painless for members. It’s essentially a workflow-orchestrating companion: fewer phone calls, fewer delays, fewer “we’re still checking with your insurer.”

Together, they’re the infrastructure for what Medi Assist calls Sustainable Benefits and Effortless Experience – two phrases we’ve heard before but never with this level of operational backbone.

4. India needs a unified codebook for AI effectiveness

BCG’s stance on this subject is as blunt as it can be, that India’s healthcare system leaks because it speaks too many dialects of data.

A unified national codebook, real-time data exchange (via ABDM and NHCX), and governed GenAI are the non-negotiables. Without standardisation, AI is just a fancy patch on a leaky bucket. This is the difference between using AI on the system versus building the system for AI, according to BCG.

5. “Insurance for All” depends on fixing the 8% FWA

According to BCG, cracking down on that middle 8% of FWA could accelerate the Indian government’s “Insurance for All” target by five years.

Think about that for a second – a half-decade leap, unlocked not by new hospitals or new policies, but just by better data governance and AI-led transparency. And suddenly it starts to look less like a healthcare efficiency plan but more a nation-building one.

Of course, it’s easier said than done, we all know healthcare in India can be an infuriating experience at times. But it looks like, from what I saw at Raksha Summit 2025, that India finally has the tools and the semblance of a unified roadmap to fix the Indian healthcare industry.

Not with fax machines. Not with paperwork. But with intelligence – artificial, yes, but also intentional. And that might just be the breakthrough India’s healthcare system has been waiting for.

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Jayesh Shinde

Executive Editor at Digit. Technology journalist since Jan 2008, with stints at Indiatimes.com and PCWorld.in. Enthusiastic dad, reluctant traveler, weekend gamer, LOTR nerd, pseudo bon vivant. View Full Profile