3 Hospitals In Jember Allegedly Manipulating BPJS Health Claims

Illustration of BPJS Kesehatan (ANTARA)

JAMBER - Three hospitals in Jember Regency, East Java, are suspected of cheating by manipulating or marking up claims by the National Health Insurance (JKN) program to BPJS Kesehatan.

This information was conveyed by the Head of BPJS Kesehatan Jember Branch, Yessy Novita, in a hearing meeting with Commission D of the Jember DPRD, the Health Service, and 14 hospitals operating in the area, Thursday, November 6.

"We have carried out our duties according to our authority, including imposing sanctions as stipulated in the Minister of Health Regulation Number 16 of 2019," Yessy said as quoted by Antara.

According to Yessy, BPJS Kesehatan has given written sanctions to three hospitals that are indicated to have committed fraud. In addition, the three hospitals also agreed to return state losses according to the value of the findings that had been verified by the officers.

"They have stated that they have the ability to return the funds that are not appropriate. From the BPJS Kesehatan side, the steps that are our authority have been completed," he said.

However, Yessy refused to reveal the amount of mark-up value that was carried out for ethical reasons. He added that refunds began in early November 2025 and were given a deadline until December 2026.

Chairman of Commission D of the Jember DPRD, Sunarsih Horis, said the summons of 14 hospitals was carried out as an anticipatory measure so that similar cases would not be repeated in other health facilities in collaboration with BPJS Kesehatan.

"This issue must be a lesson together. If we immediately call the three hospitals that are indicated to have committed fraud, they can be immediately labeled guilty," he said.

Sunarsih said that all hospitals present had agreed to carry out the JKN program according to the rules and avoid practices that could cause problems in the future.