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Abstract
Fraud in financing of health insurance is alleged to have burdened the cost of health services. The government issued Permenkes 16 of 2019 concerning prevention and handling of fraud and administrative sanctions against fraud in the implementation of JKN in an effort to prevent fraud. However, there is still potential for fraud to increase with pandemic conditions. This research aims to determine the implementation of the JKN Claim and Covid-19 Claim fraud prevention system and forms of fraud at the Prabumulih City Hospital during the Covid. This research can be useful theoretically and practically both in the field of health law politics and used by the Government, BPJS Health and Hospitals in an effort to improve fraud prevention system. The research method is empirical research with primary data sources from interviews with Prabumulih City Health Office, Prabumulih City Health BPJS and 4 Hospitals in Prabumulih. Results of the study shown that implementation of the fraud prevention system for health services at Prabumulih City Hospital during Covid at the Health Service and BPJS Health KC Prabumulih was quite good, but in Prabumulih City Hospital needed to be improved. Forms of fraud that can occur during the Covid-19 Pandemic at the Prabumulih City Hospital are fee contributions to participants for the Covid-19 antigen screening examination, extending the length of treatment for Covid-19 claims, submitting repeated claims to both JKN and covid claims and use the identity of another participant by not using the finger print in the participant's eligibility check.
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References
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- Ali, Z. (2021). Metode Penelitian Hukum. Sinar Grafika.
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- Teremetskyi, V., Duliba, Y., Kroitor, V., Korchak, N., & Makarenko, O. (2021). Corruption and strengthening anti-corruption efforts in healthcare during the pandemic of Covid-19. The Medico-Legal Journal, 89(1), 25–28. https://doi.org/10.1177/0025817220971925
References
Adisasmito, W. (2016). Analisis Pengaruh Dimensi Fraud Triangle Dalam Kebijakan Pencegahan Fraud Terhadap Program Jaminan Kesehatan Nasional di RSUP Nasional Cipto Mangunkusumo. https://doi.org/http://dx.doi.org/10.7454/eki.v1i2.1871
Albrecht, W. (2012). Fraud Examination (4th ed.). Cengage Learning.
Ali, Z. (2021). Metode Penelitian Hukum. Sinar Grafika.
Anjayani, D. (2021). Analisis Kebijakan dan Implementasi Peraturan Menteri Kesehatan Nomor 16 Tahun 2019 pada Program Jaminan Kesehatan Nasional. Jurnal Jaminan Kesehatan Nasional, 1(2), 81–94. https://doi.org/10.53756/jjkn.v1i2.37
Bell, G. A., Stacy, W., & Stacy Miller, W. (2021). Fraud in the Pandemic: How COVID-19 Affects Fraud in the Pandemic: How COVID-19 Affects Qui Tam Whistleblowers and The False Claims Act Whistleblowers and The False Claims Act Fraud in the Pandemic: How COVID-19 Affects Qui Tam Whistleblowers and The False Claims Act. In Campbell Law Review (Vol. 43). https://scholarship.law.campbell.edu/clr
Bilotta, C., Zerbo, S., Perrone, G., Malta, G., & Argo, A. (2020). The medico-legal implications in medical malpractice claims during Covid-19 pandemic: Increase or trend reversal? Medico-Legal Journal, 88(1 suppl), 35–37.
Djasri, H., Rahma, P. A., Eva, D., Hasri, T., Kebijakan, P., Kesehatan, M., & Kedokteran, F. (2016). Korupsi dalam Pelayanan Kesehatan di Era Jaminan Kesehatan Nasional: Kajian Besarnya Potensi dan Sistem Pengendalian Fraud. https://doi.org/https://doi.org/10.32697/integritas.v2i1
Friedman, L. M. (2019). Sistem Hukum: Perspektif Ilmu Sosial. Nusamedia.
Fuady, M. (2017). Perbuatan melawan hukum : pendekatan kontemporer. Citra Aditya Bakti.
Kelsen, H. (2019). Teori Hukum Murni: Dasar-dasar Ilmu Hukum Normatif. Nusa Media.
Kementrian Kesehatan RI. (2020). Pedoman Pencegahan dan Pengendalian Coronavirus Disease. Direktorat Jenderal Pencegahan dan Pengendalian Penyakit .
Lino Ximines Belo, D., Diah Wahyuningsih, C., Fakultas Ilmu Sosial Dan Ilmu Poiltik Program Studi Ilmu Administrasi Publik, A., & Faklutas Ilmu Sosial Dan, D. (2021). ANALISIS KUALITAS PELAYANAN KESEHATAN PADA MASA PENDEMI COVID 19 (Studi Kasus Di Puskesmas Ngesrep Kota Semarang).
Muhaimin. (2020). Metode Penelitian Hukum. Mataram University Press.
New Perspectives on Global Health Spending for Universal Health Coverage Global report. (2018). http://apps.who.int/bookorders.
Subekti. (2015). Hukum Perjanjian: Vol. XVIII. Intermasa.
Taufik, A. (2014). Fraud dalam Asuransi Kesehatan. Fakultas Kedokteran Universitas Islam Indonesia.
Teremetskyi, V., Duliba, Y., Kroitor, V., Korchak, N., & Makarenko, O. (2021). Corruption and strengthening anti-corruption efforts in healthcare during the pandemic of Covid-19. The Medico-Legal Journal, 89(1), 25–28. https://doi.org/10.1177/0025817220971925