KPK Calls Fraud Claims BPJS Health Performed Top Management To Unscrupulous Doctors

KPK Deputy for Prevention and Monitoring Pahala Nainggolan at the KPK Jakarta Red and White Building, Tuesday, May 23. (Tsa Tsia-VOI)

JAKARTA - The Corruption Eradication Commission (KPK) revealed that fraud or fraud claims by BPJS Kesehatan in hospitals were carried out together. Owners, management, and doctors are suspected of jointly committing malicious conspiracy.

"(Those who do fraud, red) usually the owner, basically the president director, basically the top management and several unscrupulous doctors," said KPK Deputy for Prevention and Monitoring Pahala Nainggolan to reporters quoted on Thursday, July 25.

Pahala said the data regarding this fraud had been pocketed by his institution after conducting a joint audit with BPJS Health, the Ministry of Health (Kemenkes) and the Financial and Development Supervisory Agency (BPKP). The role of the gang has been known and has been submitted to the head of the anti-corruption commission.

"That's all. Actually, from the analysis audit,... plus we went to the field (already, red) pulbaket (collection of evidence and information) at that time, "he said.

"So everything has been drawn, who, what role, it's clear," continued Pahala.

Even so, Pahala does not want to talk about whether the investigation has been carried out or not. He said the matter was in the realm of prosecution.

"I don't know, don't ask me for action. Anyway, it's sent there," he said.

The KPK said there were allegations of fraud that cost the state up to Rp35 billion. This incident is said to have occurred in three hospitals with details of two in North Sumatra and one in 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.

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.