Penggunaan Finger Print Sebagai Upaya Pencegahan Fraud Dalam Penjaminan Pasien Pengguna JKN : Studi Kasus Di RSIA X Kota Kupang

  • Maria Sumiati Amabi Universitas Ivet
  • Wahyuni Arumsari Universitas Ivet
  • Dwi Nur Siti Marchamah Universitas Ivet

Abstract

Fraud in health insurance significantly burdens the financing of health services. One of the fraud prevention innovations that has been developed and implemented by health service providers is the use of fingerprints. This research uses a qualitative method with a case study approach, aiming to explore the use of finger prints in legalizing BPJS Kesehatan patient guarantee letters as an effort to prevent fraud. The research was conducted at RSIA X Kupang City. Researchers carry out assessments, determine diagnosis, plan actions and initiate actions that have been taken. The case with the initials Mrs. I came with a referral from FKTP to carry out a pregnancy check, but it was indicated that She has used another participant's JKN-KIS card. Results of the evaluation, it was found that fraud was able to be prevented by RSIA. The actions taken by officers in the outpatient registration section at RSIA based on SOP, which is a derivative of the cooperation agreement between RSIA and BPJS Kesehatan.  However, participants who do not meet these requirements have received services at FKTP as proven by the reference letter. This is indeed a challenge for BPJS Health and FKTP to innovate to overcome this problem.

References

Ashley K. Forbes Advisor. 2024 [cited 2024 Jun 17]. Insurance Fraud Statistics 2024. Available from: https://www.forbes.com/advisor/insurance/fraud-statistics/
Bauder, R., Khoshgoftaar, T. M., & Seliya N. A Survey On The State Of Healthcare Upcoding Fraud Analysis And Detection. Heal Serv Outcomes Res Methodol. 2017;17(1):31–55. Available from: https://doi.org/10.1007/s10742-016-0154-8
BPJS Kesehatan. Inovasi Fingerprint-Electronic Surat Eligibilitas Peserta (FP-ESEP) [Internet]. 2023. Available from: https://www.youtube.com/watch?v=R7JXhWGXHXY. Diakses pada: 5 Juni 2024.
Daramola, O E, Abu J M, Daramola L O, & Akande T M. Medical Identity Fraud in Health Insurance Schemes?: Creating Awareness in Nigeria. Asian J Case Reports Med Heal. 2019;2(1):1–6.
Eka P. Catat! Penyalahgunaan Kartu BPJS Bisa Dipidana. radarbali.jawapos.com [Internet]. 2023; Available from: https://radarbali.jawapos.com/berita-daerah/701028106/catat-penyalahgunaan-kartu-bpjs-bisa-dipidana
Esti W. RSUD dr Soewandhie Temukan Pasien Berobat Gunakan Kartu BPJS Orang Lain. detik.com [Internet]. 2023 Nov; Available from: https://www.detik.com/jatim/berita/d-7061812/rsud-dr-soewandhie-temukan-pasien-berobat-gunakan-kartu-bpjs-orang-lain
Faizah Y N, Musyarofah S, Anggono A. Fraud Detection in healthcare organization?: A Bibliometric Analysis Approach. 2021;1(1):96–103.
Hancock J, Khoshgoftaar T M. Medicare Fraud Detection using CatBoost. Proc - 2020 IEEE 21st Int Conf Inf Reuse Integr Data Sci IRI 2020. 2020;11(4):97–103. Available from: https://doi.org/10.1109/IRI49571.2020.00022
Hartati T S, Sakit R, Daerah U, Tulang M. Pencegahan Kecurangan ( Fraud ) Dalam Pelaksanaan Program Jaminan Kesehatan Pada Sistem Jaminan Sosial Kesehatan ( SJSN ) Di Rumah Sakit Umum Daerah Menggala. 2016;10(4):715–32.
Kalaiselvan R, Bahari A. Fingerprint Based on Medical Information & Patient Retrieval. 2021;2(2):590–9.
Kementerian Kesehatan. Peraturan Menteri Kesehatan Republik Indonesia Nomor 36 Tahun 2015 Tentang Pencegahan Kecurangan (Fraud) Dalam Pelaksanaan Program Jaminan Kesehatan Pada Sistem Jaminan Sosial Nasional. 2015.
Khotima F L, Nugraha I N A, Wardhana Z F. Analisis Alur Pelayanan Pasien Rawat Jalan BPJS Kesehatan di Rumah Sakit Mata Bali Mandara (Analysis of Outpatient Patient Service Flow of BPJS Kesehatan at Bali Mandara Eye Hospital). 2023;10(1):43–60.
Owusu-oware E, Boateng R. Biometric Technology for Fighting Fraud in National Health Insurance?: Ghana ’ s Experience. 2018;1–10.
Rismiyanto, Marchamah, D., & Arumsari, W. (2024). Hubungan Kinerja Perawat Dengan Kepuasan Pasien Di Rumah Sakit X Kabupaten Semarang. Indonesian Journal of Health Community, 5(1), 35–44. https://doi.org/https://doi.org/10.31331/ijheco.v5i1.3299
Roziqin M C, Aprilyanti C N, Farlinda S, Prakoso B H. Sistem Informasi Pelayanan Rawat Jalan Berbasis Web Menggunakan Teknologi Fingerprint Pengganti KIB. 2022;3(28):117–28.
Trisnantoro L. Awareness All parties are needed to prevent fraud. BPJS Heal Info Bull. 2015;XXIX Edition.
Wardhana A W, Zainuddin C. Implementasi Sistem Pencegahan Kecurangan Pelayanan Kesehatan di Rumah Sakit Wilayah Kota Prabumulih Pada Masa Pandemi Covid 19. 2023;3(1):42–55.
Yunita N, Ningsih E R. Tingkat Kepuasan Pasien Pengguna Sistem Pendaftaran Rawat Jalan Sistem Online. 2023. Monograf.
Published
2024-12-16
How to Cite
AMABI, Maria Sumiati; ARUMSARI, Wahyuni; MARCHAMAH, Dwi Nur Siti. Penggunaan Finger Print Sebagai Upaya Pencegahan Fraud Dalam Penjaminan Pasien Pengguna JKN : Studi Kasus Di RSIA X Kota Kupang. Indonesian Journal of Health Community, [S.l.], v. 5, n. 2, p. 74-81, dec. 2024. ISSN 2775-9997. Available at: <https://e-journal.ivet.ac.id/index.php/ijheco/article/view/3437>. Date accessed: 16 feb. 2025. doi: https://doi.org/10.31331/ijheco.v5i2.3437.

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.