UPAYA BADAN PENYELENGGARA JAMINAN SOSIAL KESEHATAN CABANG BANDUNG DALAM PENCEGAHAN KECURANGAN (FRAUD)

Abstract

Developments in health care fraud is becoming a special attention of the government. That
phenomenon is the background issuance Minister of Health Regulation Number 36 Year 2015
concerning the Prevention of Fraud In Implementation of Health Insurance Program At National
Social Security System. This study aimed to (1) analyze indications of fraud Advanced Skincare
Health Facilities (ASHF) in Bandung; (2) analyze any prevention efforts undertaken BPJS Bandung
branch in minimizing fraud in ASHF indication; (3) analyze the prospects of fraud control efforts by
BPJS Health Branch Bandung. This study used socio legal approach. This study used primary data
and secondary data. Data were collected through documentary study. Data were analyzed
qualitatively. The survey results revealed that (1) an indication of fraud in health care ASHF in
Bandung is upcoding and kickback; (2) the prevention of fraud committed by BPJS Health Branch
Bandung Bandung City Government together with the agenda of the so-called plan of action and to
maximize the role of verifiers in the field; (3) the prospects for prevention that are being developed
that software updates casemix and managed care in collaboration with the entire hospital in
Bandung.
Keywords : BPJS, health, prevention, fraud.