Fraud Issues in the National Health Insurance (Causes, Legal Impacts, Dispute Settlement and Preventive Measures)

Yohanes Firmansyah; Imam Haryanto; Ernawati Ernawati

doi:10.55927/mudima.v2i4.272

Authors

Yohanes Firmansyah Pembangunan Nasional Veteran University, Jakarta
Imam Haryanto Pembangunan Nasional Veteran University, Jakarta
Ernawati Ernawati Tarumanagara University, Jakarta

DOI:

https://doi.org/10.55927/mudima.v2i4.272

Keywords:

fraud; national health insurance; BPJS/JKN/KIS; criminal code; dispute settlement

Abstract

National Health Insurance which covers all financing of health services in terms of national insurance. This causes the National Health Insurance to manage a very large amount of money and has an impact on many challenges regarding overcoming fraud committed by various parties. This research is a literature search that analyzes the concept of fraud, legal impact, dispute resolution, and preventive actions in dealing with and preventing fraud. The legal basis used is very diverse, starting from the regulations governing national health insurance, as stated in Presidential Regulation no. 12 of 2013 concerning Health Insurance and the Law of the Republic of Indonesia Number 24 of 2011 concerning the Social Security Administering Body; The legal implications contained in the criminal code of law; and prevention of fraud as regulated in PERMENKES RI 269/MENKES/PER/III/2008 concerning Medical Records and Regulation of the Minister of Health of the Republic of Indonesia Number 36 of 2015 concerning Prevention of Fraud in the Health Insurance Program in the National Social Security System

References

Azwar, A. (1996). Pengantar Administrasi Kesehatan (1st ed.). Binarupa Aksara.

Hall, J. A. (2011). Accounting Information Systems: Seventh Edition (Mason (ed.); 7th ed.). Cengage Learning.

Hatta, G. R. (2011). Pedoman Manajemen Informasi Kesehatan di Sarana Pelayanan Kesehatan (2nd ed.). UI-Press.

Ibrahim, J. (2006). Teori & Metodologi Penelitian Hukum Normatif.

Kementrian Kesehatan RI. (2008). PERMENKES RI 269/MENKES/PER/III/2008. In Permenkes Ri No 269/Menkes/Per/Iii/2008 (Vol. 2008, p. 7).

UNDANG-UNDANG REPUBLIK INDONESIA NOMOR 24 TAHUN 2011 TENTANG BADAN PENYELENGGARA JAMINAN SOSIAL, 16 119 (2011).

Kementrian Kesehatan RI. (2015). Peraturan Menteri Kesehatan Republik Indonesia Nomor 36 tahun 2015 Tentang Pencegahan Kecurangan (Fraud) Dalam program Jaminana Kesehatan Pada Sistem Jaminan Sosial Nasional. 1–97. www.hukor.depkes.go.id

Marpaung, L. (2005). Asas, Teori dan Praktik Hukum Pidana (1st ed.). Sinar Grafika.

Mukti, A. G., & Moertjahjo. (2008). Sistem Jaminan Kesehatan: Konsep Desentralisasi Terintegras (1st ed.). PT.KHM.

Murti, B. (2000). Dasar-Dasar Asuransi Kesehatan. Penerbit Kanisius.

Nurbaningsih, E. (2015). Kitab Undang-Undang Hukum Pidana (KUHP). In B Indonesia.

Nurman, A., & Martini, A. (2008). Merumuskan Skema Penyediaan Jaminan Pelayanan Kesehatan yang Sesuai untuk Daerah. (1st ed.). Perkumpulan Inisiatif.

Presiden Republik Indonesia. (2013). Peraturan Presiden No. 12 tahun 2013 Tentang Jaminan Kesehatan (p. 39).

The Institute of Internal Auditor, The American Institute of Certified Public Accountants, And Examiners, A. of C. F. (2008). Managing the Business Risk of Fraud: A Practical Guide. The Institute of Internal Auditor, The American Institute of Certified Public Accountants, And Examiners, Association of Certified Fraud.

The Institute of Internal Auditor. (2005). Internal Auditing and Fraud. The Institute of Internal Auditor. https://na.theiia.org