The Implementation of Fraud Prevention on the National Health Insurance at Salewangan Maros Hospital, Indonesia: A Qualitative Study

Authors

  • Fitri Indayani
  • Reza Aril Ahri
  • A. Rizki Amelia
  • Fatmah Afriyanti Gobel
  • Fairus Prihatin Idris

DOI:

https://doi.org/10.37506/ijfmt.v16i1.17500

Keywords:

Fraud Prevention, Indonesia, National Health Insurance

Abstract

Background: Various fraud control methods are designed to overcome potential fraud that occurs by
every element that involved in the National Social Health Insurance System in Indonesia. This study
aims to analyze how the implementation of fraud prevention efforts that have been carried out by the
National Health Insurance (JKN) Fraud Prevention Team which was formed at the SalewanganMaros
Regional Hospital. Method: This study used a descriptive qualitative approach with data collection
techniques through in-depth interviews and observation. The informants were the Head of the Service
Division, the Chair of the Hospital Medical Committee, the Head of the Nursing Sub-Division, the Head
of the Finance Sub-Division, and the Casemix team.Results:Efforts to increase the fraud prevention is
still weak, efforts to detect and resolve fraud are already underway, but efforts to detect fraud have not
been continuous, detection through observation at service locations is not routinely carried out, while
detection efforts through data analysis still rely on service data feedback obtained from BPJS, as well
as monitoring and evaluation by the Fraud Prevention Team at SalewanganMaros Regional Hospital
has been implemented but is still very poor.Conclusion: Fraud prevention efforts must be carried out
comprehensively and involve all individuals. There must be an automated integrated system at each
service point so that fraud prevention can be optimized.

Author Biographies

Fitri Indayani

Magister Program in Public Health, Universitas Muslim Indonesia, Makassar, South Sulawesi, Indonesia, National Health Insurance, South Sulawesi Branch, Makassar, Indonesia

Reza Aril Ahri

National Health Insurance, South Sulawesi Branch, Makassar, Indonesia, Departement of Public Health, Faculty of Public Health, Universitas Muslim Indonesia, Makassar, South Sulawesi, Indonesia

A. Rizki Amelia

National Health Insurance, South Sulawesi Branch, Makassar, Indonesia, Departement of Public Health, Faculty of Public Health, Universitas Muslim Indonesia, Makassar, South Sulawesi, Indonesia

Fatmah Afriyanti Gobel

National Health Insurance, South Sulawesi Branch, Makassar, Indonesia, 3Departement of Public Health, Faculty of Public Health, Universitas Muslim Indonesia, Makassar, South Sulawesi, Indonesia

Fairus Prihatin Idris

National Health Insurance, South Sulawesi Branch, Makassar, Indonesia, Departement of Public Health, Faculty of Public Health, Universitas Muslim Indonesia, Makassar, South Sulawesi, Indonesia

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Published

2021-11-30

How to Cite

Fitri Indayani, Reza Aril Ahri, A. Rizki Amelia, Fatmah Afriyanti Gobel, & Fairus Prihatin Idris. (2021). The Implementation of Fraud Prevention on the National Health Insurance at Salewangan Maros Hospital, Indonesia: A Qualitative Study. Indian Journal of Forensic Medicine & Toxicology, 16(1), 494–501. https://doi.org/10.37506/ijfmt.v16i1.17500