Effectiveness of Administrative Sanctions in Overcoming Fraud by Health Facilities on JKN Participants

Purnomo Purnomo; Zainal Arifin Hosein

doi:10.62383/desentralisasi.v2i1.426

Authors

Purnomo Purnomo Universitas Borobudur
Zainal Arifin Hosein Universitas Borobudur

DOI:

https://doi.org/10.62383/desentralisasi.v2i1.426

Keywords:

Fraud, JKN, Administrative Sanctions, Health Facilities

Abstract

This study discusses the effectiveness of implementing administrative sanctions to overcome fraud practices by health facilities against National Health Insurance (JKN) participants in Indonesia. Fraud practices involving claim manipulation, bill inflation, and falsification of diagnoses result in losses for JKN participants and reduce the quality of health services. This study identifies challenges in supervision, regulatory weaknesses, and obstacles in law enforcement that affect the effectiveness of the administrative sanctions imposed. Based on the analysis, this study recommends regulatory reforms that include the implementation of stricter sanctions, strengthening supervision with information technology, and increasing outreach programs to raise awareness of the impacts of fraud. It is expected that with this reform, the JKN system can run more effectively and reduce fraud practices that are detrimental to all parties.

Downloads

Download data is not yet available.

References

Afriko, J. (2016). Hukum kesehatan (teori dan aplikasinya). In Media.

Alfrida. (2020). Risiko K3 rumah sakit dan fasyankes selama pandemi COVID-19. Kartini.

Asyhadie, Z. (2015). Aspek-aspek hukum kesehatan. Raja Grafindo.

Badan Penyelenggara Jaminan Sosial. (2014). Petunjuk teknis verifikasi klaim direktorat pelayanan. Badan Penyelenggara Jaminan Sosial (BPJS).

Budianto, A. G. (2010). Aspek jasa pelayanan kesehatan dalam perspektif pelindungan pasien. Karya Putra Darwanti.

Feriawati, D. (2015). Faktor-faktor keterlambatan pengeklaiman BPJS di Rumah Sakit Bhayangkara. Gramedia.

Hady, I. (2017). Etika profesi aspek hukum bidang kesehatan. Bhakti Persada.

Herawati, N. (2020). Aspek, hukum dan kesehatan kerja bagi tenaga medis saat pandemi. Citra Pustaka.

Murti, B. (2004). Dasar-dasar asuransi kesehatan. Kanisius.

Notoatmojo, S. (2010). Promosi kesehatan teori dan aplikasi. Rineka Cipta.

Praptianingsih, S. (2006). Kedudukan hukum perawat dalam upaya pelayanan kesehatan di rumah sakit. Raja Grafindo Persada.

Rusyad, Z. (2018). Hukum perlindungan pasien: Konsep perlindungan hukum terhadap pasien dalam pemenuhan hak kesehatan oleh dokter dan rumah sakit. Setara Press.

Solehuddin. (2023). Urgensi kriminalisasi perbuatan kecurangan (fraud) dalam pelaksanaan program jaminan kesehatan di Indonesia. IDJ: Indonesian Journal of Law, 4(1).

Wijaya, A. (2018). Hukum jaminan sosial Indonesia. Sinar Grafika.