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KPK says fraud within Indonesia's healthcare sector causes Rp20tn of loss

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Tempo - September 20, 2024

Mutia Yuantisya, Jakarta – The Deputy Head of Corruption Eradication Corruption (KPK), Alexander Marwata, asks the state-owned Healthcare and Social Security Agency (BPJS Kesehatan) to prioritize integrity within its fund management.

As of 2024, he said, BPJS Kesehatan allotted around Rp150 trillion to support the healthcare of 98 percent of registered Indonesian citizens.

"(The fund) comprises premiums and government subsidies through State Budget and Regional Budget, signifying state fund and public fund within (BPJS Kesehatan's) finance. These funds must be managed," said Alexander in an official statement, on Friday, September 20, 2024.

However, in reality, he said, there is still fraud in the healthcare sector. According to him, lack of integrity can lead to misuse of funds, lower public trust, and threaten the sustainability of the National Health Insurance (JKN) program in the future.

The KPK official said fraud causes damage of about Rp20 trillion, or 10 percent of BPJS Kesehatan's public health spending. Fraud includes manipulation or phantom billing carried out by health facilities, both central and regional, which cooperate with BPJS Kesehatan.

Another case of fraud is the manipulation of data regarding BPJS Kesehatan holders, as well as operating unnecessary services for profit, such as excessive medical procedures or administering unnecessary drugs.

For this reason, KPK strives to prevent fraud within the system by developing an ecosystem with integrity with related stakeholders, thereby reducing the risk of fraud and corruption.

"I emphasize that corruption eradication does not depend solely on KPK, but our collective duty," he said.

On the same occasion, the President Director of BPJS Kesehatan, Ghufron Mukti, conveyed the importance of synergy between government agencies, health facilities, and professional associations to support the sustainability and improvement of the JKN program.

To prevent fraud, KPK, BPJS, the Ministry of Health, and the Financial and Development Supervisory Agency (BPKP) formed a JKN Fraud Prevention Team (PK).

In 2023, fraud tracing or detection was carried out in three health facilities for Cataract, Sectio Caesarea, and Hemodialysis services. Fraud handling was also conducted in three hospitals in North Sumatra and Central Java.

Source: https://en.tempo.co/read/1918727/kpk-says-fraud-within-indonesias-healthcare-sector-causes-rp20tn-of-los

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