Allegations Of BPJS Health Fictitious Claims By 3 Hospitals Are Still Being Processed By The KPK

JAKARTA - The Corruption Eradication Commission (KPK) said the alleged fictitious claims by BPJS Kesehatan carried out by three hospitals were still in the process of being investigated. This step was taken after the findings entered the leadership table.

"Until now, the prosecution is still taking action regarding the BPJS fictitious claim," said KPK Spokesperson Tessa Mahardika to reporters quoted on Tuesday, July 30.

Tessa said that this review process needed to be carried out to ensure that this fraud was entitled to be handled by the anti-corruption commission in accordance with Article 11 of Law Number 19 of 2019. That involves law enforcement officers, state administrators, and other people related to the criminal act of corruption committed," he said.

"And/or regarding state losses worth Rp. 1 billion. (If that element is fulfilled, red) it is very likely that it will be handled by the KPK," he continued.

However, if this element is not fulfilled, the institution cannot handle the alleged fraud that occurred. (We, ed) will coordinate with other law enforcers through the supervision section in the KPK," explained Tessa.

Previously reported, the KPK mentioned allegations of fraud that cost the state up to Rp35 billion. This incident is said to have occurred in three hospitals, namely two in North Sumatra and one in Central Java.

This finding was obtained after a joint audit with BPJS Kesehatan, the Ministry of Health (Kemenkes) and the Financial and Development Supervisory Agency (BPKP) was conducted.

The fraudulent mode that occurs is in the form of manipulation of medical records. The total findings are more than three thousand fictitious claims.

In addition, this hospital inflated the amount of medical treatment to get more profit. Some of the findings even used the names of BPJS participants who had never been treated to make claims.

As a result of these findings, the anti-corruption commission suspects that two frauds occurred. The details are phantom billing, namely claims without any patient and an inappropriate medical diagnosis or manipulation diagnostic.