Fraud Prevention System with Whistleblowing System in Health Services: A Systematic Review

Ridwan Ridwan; Said Munadi; Heru Fahlevi; Nadirsyah Nadirsyah

doi:10.53756/jjkn.v4i1.182

Authors

Ridwan Ridwan Universitas Syiah Kuala, Prodi Magister Akuntansi
Said Munadi Syaih Kuala University
Heru Fahlevi Syaih Kuala University
Nadirsyah Nadirsyah Syaih Kuala University

DOI:

https://doi.org/10.53756/jjkn.v4i1.182

Keywords:

fraud, whistleblowing, Health service, Bibliography

Abstract

The objective of this study is to ascertain the strategies employed in mitigating fraudulent activities within the realm of health services through the utilization of a whistleblowing mechanism. Methods: The present study employed a systematic review approach to examine relevant literature by utilizing specific keywords such as "whistleblowing system" and "fraud Healthcare." These keywords were then used to search for publications in the Scopus database, focusing on journals that mostly relied on secondary data. The search was conducted using the publish or perish tool. 8. Subsequently, a curation of scholarly publications and articles was conducted, employing a criterion centered on the thematic relevance of their titles. The selected publications have the objective of mitigating fraudulent activities within the healthcare industry and other interconnected industries that contribute to research endeavors. The findings of this study suggest that the implementation of a fraud reporting system is vital inside an organization, particularly within the context of health services. To enhance the caliber of healthcare services, internal healthcare staff and participants may report well, it is imperative to establish a system that ensures the preservation of reporter confidentiality, hence facilitating an increase in the volume of reports.

References

Abdallah, A., Maarof, M. A., & Zainal, A. (2016). Fraud detection system: A survey. Journal of Network and Computer Applications, 68, 90–113. https://doi.org/10.1016/j.jnca.2016.04.007

Ciasullo, M. V., Cosimato, S., & Palumbo, R. (2017). Improving health care quality: The implementation of whistleblowing. TQM Journal, 29(1), 167–183. https://doi.org/10.1108/TQM-06-2016-0051

Djamhari, E. A., Aidha, C. N., Ramdlaningrum, H., Kurniawan, D. W., Fanggidae, S. J., Herawati, Ningrum, D. R., Thaariq, R. M., Kartika’, W., & Chrisnahutama, A. (2020). Defisit Jaminan Kesehatan Nasional ( JKN ): Mengapa dan Bagaimana Mengatasinya ? Cetakan 1, 67–68.

Hamed, M. M. M., & Konstantinidis, S. (2022). Barriers to Incident Reporting among Nurses: A Qualitative Systematic Review. In Western Journal of Nursing Research (Vol. 44, Issue 5, pp. 506–523). SAGE Publications Inc. https://doi.org/10.1177/0193945921999449

Handoko, B. L., & Amelia, R. (2021). Implementation of good corporate governance, internal audit, whistle-blowing system for fraud prevention in state-owned enterprise. ACM International Conference Proceeding Series, 305–310. https://doi.org/10.1145/3481127.3481144

Jackson, D., Hickman, L. D., Hutchinson, M., Andrew, S., Smith, J., Potgieter, I., Cleary, M., & Peters, K. (2014). Whistleblowing: An integrative literature review of data-based studies involving nurses. Contemporary Nurse, 48(2), 240–252. https://doi.org/10.1080/10376178.2014.11081946

Jones, A. (2016). The role of employee whistleblowing and raising concerns in an organizational learning culture – Elusive and laudable? Comment on “Cultures of silence and cultures of voice: The role of whistleblowing in healthcare organisations.” International Journal of Health Policy and Management, 5(1), 67–69. https://doi.org/10.15171/ijhpm.2015.182

Makowsky, M. D., & Wang, S. (2018). Embezzlement, whistleblowing, and organizational architecture: An experimental investigation. Journal of Economic Behavior and Organization, 147, 58–75. https://doi.org/10.1016/j.jebo.2017.12.024

Mannion, R., & Davies, H. T. (2015). Cultures of silence and cultures of voice: The role of whistleblowing in healthcare organisations. International Journal of Health Policy and Management, 4(8), 503–505. https://doi.org/10.15171/ijhpm.2015.120

Mohd Noor, N. R. A., & Mansor, N. (2019). Exploring the Adaptation of Artificial Intelligence in Whistleblowing Practice of the Internal Auditors in Malaysia. Procedia Computer Science, 163, 434–439. https://doi.org/10.1016/j.procs.2019.12.126

Othman, R., Aris, N. A., Mardziyah, A., Zainan, N., & Amin, N. M. (2015). Fraud Detection and Prevention Methods in the Malaysian Public Sector: Accountants’ and Internal Auditors’ Perceptions. Procedia Economics and Finance, 28(April), 59–67. https://doi.org/10.1016/s2212-5671(15)01082-5

Pamungkas, I. D., Ghozali, I., & Achmad, T. (2017). The effects of the whistleblowing system on financial statements fraud: Ethical behavior as the mediators. International Journal of Civil Engineering and Technology, 8(10), 1592–1598.

Rauwolf, P., & Jones, A. (2019). Exploring the utility of internal whistleblowing in healthcare via agent-based models. BMJ Open, 9(1), 1–12. https://doi.org/10.1136/bmjopen-2018-021705

Sunarti, S., Ghozali, M. T., Haris, F., Rahman, F. F., Rahman, R. A., & Ghozali. (2020). Preventing fraud and deficit through the optimization of health insurance in Indonesia. Systematic Reviews in Pharmacy, 11(7), 228–231. https://doi.org/10.31838/srp.2020.7.36

van Capelleveen, G., Poel, M., Mueller, R. M., Thornton, D., & van Hillegersberg, J. (2016). Outlier detection in healthcare fraud: A case study in the Medicaid dental domain. International Journal of Accounting Information Systems, 21, 18–31. https://doi.org/10.1016/j.accinf.2016.04.001

Vrbnjak, D., Denieffe, S., O’Gorman, C., & Pajnkihar, M. (2016). Barriers to reporting medication errors and near misses among nurses: A systematic review. In International Journal of Nursing Studies (Vol. 63, pp. 162–178). Elsevier Ltd. https://doi.org/10.1016/j.ijnurstu.2016.08.019

Wahyudi, S., Achmad, T., & Pamungkas, I. D. (2019). Whistljeblowing system and fraud early warning system on village fund fraud: The Indonesian experience. International Journal of Financial Research, 10(6), 211–217. https://doi.org/10.5430/ijfr.v10n6p211

Wahyudi, S., Achmad, T., & Pamungkas, I. D. (2021). Village apparatus competence, individual morality, internal control system and whistleblowing system on village fund fraud. WSEAS Transactions on Environment and Development, 17(6), 672–684. https://doi.org/10.37394/232015.2021.17.65

Wang, D., & Zhan, C. (2022). Why Not Blow the Whistle on Health Care Insurance Fraud? Evidence from Jiangsu Province, China. Risk Management and Healthcare Policy, 15, 1897–1915. https://doi.org/10.2147/RMHP.S379300

Yung, H. P., Yu, S., Chu, C., Hou, I. C., & Tang, F. I. (2016). Nurses’ attitudes and perceived barriers to the reporting of medication administration errors. Journal of Nursing Management, 24(5), 580–588. https://doi.org/10.1111/jonm.12360