Monday, 17 June 2019 | 12:14 WIB

Fraud Hits JKN Service, Contracts of 70 Hospitals Terminated

Fraud Hits JKN Service, Contracts of 70 Hospitals Terminated (nnc)

JAKARTA, NNC - The National Health Social Security (JKN) services through the Health Social Security Agency (BPJS Kesehatan) are suspected of being full of fraud practices. As a result, there are 70 hospitals that were immediately terminated due to suspected fraud practices.
This was confirmed by Maya A. Rusady, Director of Health Services Guarantee at BPJS Kesehatan in the LIFAI Discussion Forum Discussion on "Fraud Prevention, for JKN Sustainability" which was held by the Indonesian Insurance Anti-Fraud Institution (LAFAI) in Jakarta on Wednesday (03/06/2019).
"We have terminated the collaboration with 70 hospitals because of things like this. There is a hospital that we clearly found is not in accordance with its class, there are also doctors who do upcoding or code filling is done by staff--which should have been done by the doctors," Maya said.
She admitted that BPJS Kesehatan participants had reached 218 million people. However, more than 50 percent of health services are in privately owned facilities. In fact, she said, there were 640,000 residents who used the Indonesia Healthy Card (KIS) every day.
"Fraud can occur if there is an opportunity. This can happen anywhere by anyone. We also, in providing this service, there is an imbalance between revenue and spending from the aspect of contributions," Maya said.
M Nasser, expert council of the Indonesian Doctors Association (IDI), said fraud in JKN was all forms of fraud with intentional elements that were submitted as false claims. So, he said, not all frauds could be charged by law if it was not intentional.
"There are many kinds of fraud practices. However, who needs to be arrested in public law is that it is detrimental because it submits claims that must be paid even though false claims. Losses due to fraud in the US are around 7 percent of the current budget. 5-8 percent too, "Nasser said.
He considers that fraud will drain BPJS funds if not addressed immediately. Moreover, at this time there has been a quite high BPJS Kesehatan budget deficit. According to him, fraud is more often done by the hospital and individual doctors on the island of Java.
Chairman of the Indonesian Insurance Anti Fraud Institute (LAFAI), Nurfaidah Ahmad said, one of the main requirements for the sustainability of the JKN program was to prevent fraud. According to him, fraud is a major factor in the deficit experienced by BPJS Kesehatan.
"Prevention efforts must take precedence, so that there will not be too many victims due to fraud, which will directly or indirectly affect the sustainability of JKN administration," he said.
In this case, his party mapped at the point of potential fraud in the implementation of JKN programs. Both in terms of planning, implementation, and monitoring and evaluation carried out.
"Actually the issues that have surfaced so far can be identified and can even be overcome. Such as the Social Security Fund deficit, waiting list of participants in the Advanced Health Facilities (FKRTL), barrier-free First Level Health Facilities (FKTP) , arrears of contributions, Out Of Pocket (OOP), decrease in service quality, etc., "he said.