THE ANALYSIS OF THE IMPLEMENTATION OF THE NATIONAL HEALTH INSURANCE FRAUD PREVENTION PROGRAM
Abstrak
Program Jaminan Kesehatan Nasional (JKN) yang diselenggarakan oleh Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan merupakan salah satu upaya strategis pemerintah Indonesia untuk mewujudkan sistem kesehatan yang inklusif dan merata bagi seluruh masyarakat. Program ini menghadapi berbagai tantangan serius, salah satunya adalah masalah fraud atau kecurangan. Penelitian ini bertujuan untuk menganalisis pelaksanaan program pencegahan fraud dalam JKN, mengidentifikasi hambatan yang dihadapi, dan mengevaluasi efektivitas strategi yang diterapkan. Penelitian ini bersifat kualitatif dengan menggunakan teknik pendekatan sistematik review. Artikel yang digunakan dalam penelitian ini merupakan teks full artikel dengan desain studi observasional yang dipublikasikan dari tahun 2016 hingga tahun 2024. Variabel independen meliputi program ansuransi jaminan kesehatan nasional, dan variable dependen yaitu kecurangan fraud ansuransi. Pengumpulan data artikel dilakukan dengan mencari artikel pada search database database Google Scholar, ProQuest, dan Science Direct. Negara Indonesia telah Membentuk tim anti-fraud, namun belum berfungsi maksimal karena kurangnya pengetahuan mengenai pencegahan penipuan dalam program JKN. Masih banyak yang belum melaksanakan program pencegahan (FRAUD) dengan optimal, dari berbagai dilayah di Indonesia.
Referensi
Rizka, Z., Jati, S. P., & Syamsulhuda, B. M. (2018). Analysis of the implementation of the National Health Insurance fraud prevention program (FRAUD) at the Semarang City Health Center. Journal of Public Health, 6(4), 95-104. Adisasmito, W. (2016). Analysis of the influence of the fraud triangle dimension in fraud prevention policies on the national health insurance program at the Cipto Mangunkusumo National Hospital. Indonesian Journal of Health Economics, 1(2). Hartati, T. S. (2016). Prevention of fraud in the implementation of the health insurance program in the Health Social Security System (SJSN) (Study at the Menggala Tulang Bawang Regional General Hospital). Fiat Justisia: Journal of Law, 10(4), 715-732. Marasabessy, Y. (2016). The Effect of Internal Control on Fraud Prevention (FRAUD) in the Implementation of Health Insurance at Bhayangkara Kindergarten IV Hospital, Maluku Police. Advantage, 5(1), 31-35. Solehuddin, S. (2023). The Urgency of Criminalizing Fraud in the Implementation of the Health Insurance Program in Indonesia. INTERDISCIPLINARY JOURNAL ON LAW, SOCIAL SCIENCES AND HUMANITIES, 4(1), 55-75. Thaifur, A. Y. B. R., Maidin, M. A., Sidin, A. I., & Razak, A. (2021). How to detect healthcare fraud?" A systematic review". Gaceta sanitaria, 35, S441-S449. Soputan, R., Tinangon, J., & Lambey, L. (2018). Analysis of Fraud Risk on the National Health Insurance Capitation Fund Management System at the Bitung City Government FKTP. JOURNAL OF ACCOUNTING AND AUDITING RESEARCH "GOODWILL", 9(2). Fatimah, R. N., & Misnaniarti, S. R. (2021). Determinants of Potential Fraud in the JKN DI Program at the City X Health Center. PREPOTIF J Kesehat Masy, 5(1), 46-54. Indrawan, G., Lemes, I. N., & Surata, I. N. (2024). The role of the Health Office in the prevention and handling of fraud (FRAUD) in the implementation of the health insurance program based on the Regulation of the Minister of Health of the Republic of Indonesia No. 16 of 2016 Buleleng district. Kertha Widya, 11(2), 59-84. Bramasto, A., Dewi Anggadini, S., Hasanah, U., & Nur Azizah, N. (2022). Fraud prevention with internal audits and internal controls. Journal of Accounting, 11(1). Budiantoro, H., Aprillivia, N. D., & Lapae, K. (2022). The effect of GCG implementation, anti-fraud awareness, and employee integrity on fraud prevention. Journal of Orientai Business and Entrepreneurship, 3(1), 28-39.
Putri, P. M., & Murdi, P. B. (2019). Health services in the era of national health insurance as a program of the health social security organizing agency. Journal of Legal Discourse, 25(1), 80. Wulandari, D. N., & Nuryanto, M. (2018). The influence of internal control, anti-fraud awareness, integrity, independence, and professionalism on fraud prevention. Mercu Buana Accounting Research Journal, 4(2), 117-125.
PMK, NO 16 (2019). Prevention and Handling of Fraud and the Imposition of Administrative Sanctions for Fraud in the Implementation of the Health Insurance Program. Retrieved from https://peraturan.bpk.go.id/Details/129762/permenkes-no-16-tahun-2019
PMK, NO 36 (2015). Prevention of fraud in the implementation of the health insurance program in the national social security system. Retrieved from https://peraturan.bpk.go.id/Details/116174/permenkes-no-36-tahun-2015
BPJS Kesehatan (2020). With the digitization of the JKN program, it is getting easier. Retrieved from https://www.bpjs-kesehatan.go.id/
BPJS, U. U. (2020). List of Regulations in the field of BPJS Kesehatan. Retrieved from https://www.apindokaltara.com/berita/layanan/bpjs-kesehatan
BPJS Kesehatan. (2023). Sample Data 2023. https://data.bpjs-kesehatan.go.id/bpjs-portal/action/landingPage.cbi.
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2024-06-01
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safitri, auliya, Karlinda, & Nurcihikita, T. (2024). THE ANALYSIS OF THE IMPLEMENTATION OF THE NATIONAL HEALTH INSURANCE FRAUD PREVENTION PROGRAM. Journal of Health Management, Administration and Public Health Policies, 2(1), 52–63. https://doi.org/10.52060/hmaps.v2i1.2217
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