Here is the role of local authorities in preventing JKN-KIS program fraud

BigBussiness – BPJS Kesehatan urges local authorities to optimize efforts against fraud in the National Health Insurance-Indonesian Health Card Program (JKN-KIS).

This was revealed by the director of BPJS Kesehatan health service guarantee Maya Amiarny Rusady in the webinar on the role of the local authority in the prevention of JKN fraud, Thursday (27/8/2020).

“Quality service becomes a major collaborative action of all stakeholders. The regional government is one of the main stakeholders of BPJS Kesehatan in the implementation of the JKN-KIS program. It is very important for local authorities to understand their role in preventing fraud in the implementation of the national health insurance in each region, says Maya.

Maya said local authorities need to focus on efforts to prevent fraud. This can be done through the preparation of supporting regulations in each area as a derivative of the Minister of Health’s regulation number 16 of 2019 on prevention and management of fraud and the introduction of administrative sanctions against fraud (Implementation of the Health Insurance Program).

In accordance with the main function, BPJS Kesehatan has developed efforts to prevent fraud, one of which is through the digitization of services. From the development of the use of biometrics, data analysis technology and machine learning. BPJS Kesehatan has implemented digital-based verification of service requirements (Vedika).

According to Maya, the system is now more mature, and registers a lot of data every day. From this data, it continues to grow to produce analytical data including analytical data that has the potential / leads to fraud.

BPJS Kesehatan also uses machine learning technology in an attempt to minimize the potential for fraud. This technology uses an algorithm from the user whose function is to study the entered requirements, Maya added.

In line with Maya, Inspector 1 of the Ministry of Health and Chairman of the Central Level of the Fraud Prevention Team, Edward Harefa revealed that the local authorities and health facilities that cooperate with BPJS Kesehatan and implement the JKN-KIS program must begin to develop supportive regulations, develop a culture for fraud in the program. JKN, develops quality control-oriented services and cost control in the JKN program, and creates a fraud prevention team in the JKN-KIS program in each region.

“The Ministry of Health has monitored and evaluated the implementation of fraud prevention work in the JKN-KIS program at the Health Office, vertical hospitals and FKTPs. The monitoring results show that there is a need to socialize again and understand deeply about Permenkes 16/2019 together with its technical guidelines for Provincial, District / City Health Office, FKTP and FKTRL, as well as monitor activities from the Anti-Fraud Team in the JKN program at central, provincial and provincial levels. Regency / City, “said Edward.

In addition, it is also necessary to integrate a system for the prevention, detection and management of fraud in all areas of the JKN-KIS program. Edward revealed that a systematic effort must be made by the District / City Health Office to formulate guidelines, implement and monitor and evaluate their work areas.

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