UPAYA DINAS KESEHATAN KOTA PADANG DALAM MEMBANGUN SISTEM PENCEGAHAN KECURANGAN (FRAUD) JAMINAN KESEHATAN NASIONAL PADA FASILITAS KESEHATAN TINGKAT PERTAMA

Abstract

The national health insurance program is regulated by Law Number 40 of 2004. The National Health Insurance Program is implemented by the Health Social Security Organizing Agency (BPJS Kesehatan). In order to guarantee the absence of fraud in the national health insurance system, the Minister of Health Regulation No. 36 of 2015 concerning Fraud Prevention is issued. Based on the Ministerial Regulation, the District and City Health Offices are required to establish an anti-fraud system in the implementation of the National Social Security system. Research problems: 1. What are the steps taken by the Padang City Health Office in preventing fraud (Fraud) in National Health Insurance? 2. What are the constraints of the Health Office in building the anti-Fraud system in Padang City? This study used a socio-legal approach. Data sources used were primary data and secondary data. Secondary data was collected by document study and primary data is collected by interview. Based on the research, it can be concluded that: 1. the efforts made by the Padang City Health Office in developing fraud (Fraud) prevention system through socialization, and technical guidance to existing health centers in Padang City. While training and capacity building of human resources; and monitoring and evaluation have not been fully implemented. 2. The obstacle faced by the Health Office is that the work program and budget are not yet sufficient.

Keywords: Fraud, BPJS, National Health Insurance, Health Service