ANALISIS MANAJEMEN PENANGGULANGAN POTENSI FRAUD DALAM PELAYANAN PROGRAM JKN-KIS PADA 3 RUMAH SAKIT DI KOTA PALEMBANG

EMILYA, MELDA and Misnaniarti, Misnaniarti and Syakurah, Rizma Adlia (2022) ANALISIS MANAJEMEN PENANGGULANGAN POTENSI FRAUD DALAM PELAYANAN PROGRAM JKN-KIS PADA 3 RUMAH SAKIT DI KOTA PALEMBANG. Master thesis, Sriwijaya University.

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Abstract

Fraud is a deliberate act of fraud to obtain material and harms other parties. Fraud can occur in the problem of health financing for the JKN KIS program which has become the iceberg. The impact of fraud can affect the financial aspect, quality, and quality of the hospital as well as the image and good name of the perpetrator. This study aims to analyze the management of potential fraud prevention in the implementation of the JKN-KIS program at 3 hospitals in the city of Palembang. This research was conducted using a qualitative method with a phenomenological approach with data collection techniques using in-depth interviews, document review, and observation The validity of the data using the triangulation method. The informants in this study were 16 people who had sufficient information about fraud in 3 hospitals, BPJS Health and the Palembang City Health Office. The results show that the potential for fraud in hospitals is related to the manipulation of diagnoses and/or actions, taking treatment actions that are not by medical indications, readmissions, fee contributions, and cases of service unbundling or fragmentation. Potential fraud occurs due to ineffective internal monitoring from hospital management and ineffective external monitoring from BPJS Health and the City Health Office. The conclusion of this study is to overcome the potential for fraud, internal cooperation between the Hospital, BPJS Health and related stakeholders is needed as stated in the Minister of Health Regulation No. 16 of 2019. Keywords: Fraud Potential, Management, Hospital, National Health Insurance Literature : 52 (2002-2022)

Item Type:	Thesis (Master)
Uncontrolled Keywords:	Potensi Fraud, Manajemen, Rumah Sakit, Jaminan Kesehatan Nasional
Subjects:	Z Bibliography. Library Science. Information Resources > Z683-683.5 Finance. Insurance
Divisions:	10-Faculty of Public Health > 13101-Public Health Science (S2)
Depositing User:	Melda Emilya
Date Deposited:	10 Feb 2023 07:05
Last Modified:	10 Feb 2023 07:05
URI:	http://repository.unsri.ac.id/id/eprint/89389

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