KPK Endus Fraud Claims BPJS Which Loses Rp35 Billion To The State In 3 Hospitals

Discussion On Prevention And Handling Of Fraud In The JKN Program At The KPK's Red And White Building, Kuningan Persada, Jakarta/PHOTO: Wardhany Tsa Tsia-VOI

JAKARTA - The Corruption Eradication Commission (KPK) together with the Ministry of Health, BPJS Kesehatan, and BPKP detected fraud that cost the state up to Rp35 billion. This allegation is said to have occurred in three hospitals, one of which is in Central Java.

This was conveyed by the Deputy for Prevention and Monitoring of the KPK Pahala Nainggolan in the discussion "Prevention and Handling of Fraud in the JKN Program" at the KPK's Merah Putih building, Kuningan Persada, South Jakarta.

"We will say that there are three that we get from the audit of BPJS claims that they have been brought to this team and we say that this is seriously a fraud," Pahala said in a discussion, Wednesday, July 24.

Pahala said the team that had been made had moved to a number of hospitals to audit BPJS claims. As a result, there were findings at private hospitals with details of two in North Sumatra and Central Java.

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

"It turns out that in three hospitals there are claims of 4,341 cases but actually there are 1,000 cases in the medical record book. So about three thousand of them are claimed to be physiotherapy but actually not in medical records," said Pahala.

In addition, he continued, 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 suspected that two frauds occurred. The first is phantom billing, namely claims without any patients and inappropriate medical diagnosis.

"These three are doing phantom billing, meaning they engineered all the documents in Central Java, which are around Rp29 billion in claims, the two in North Sumatra are Rp4 billion and Rp1 billion is the result of an audit of claims by Dri BPJS Kesehatan," he explained.

Furthermore, Pahala said that this finding had been submitted to the head of the anti-corruption commission. "The result was that the leadership decided that the three were transferred to prosecution," said Pahala.

"Later, who will take care of whether the prosecutor's office is investigating or the KPK will be taken care of by the KPK leadership," he concluded.