Skripsi

ANALISIS MANAJEMEN PENANGGULANGAN POTENSI FRAUD DALAM PELAYANAN PROGRAM JKN-KIS PADA 3 RUMAH SAKIT DI KOTA PALEMBANG

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Penilaian

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Fraud is a deliberate act of fraud to obtain material and harms other parties. Fraud can occur in the problem of health financing for the JKN KIS program which has become the iceberg. The impact of fraud can affect the financial aspect, quality, and quality of the hospital as well as the image and good name of the perpetrator. This study aims to analyze the management of potential fraud prevention in the implementation of the JKN-KIS program at 3 hospitals in the city of Palembang. This research was conducted using a qualitative method with a phenomenological approach with data collection techniques using in-depth interviews, document review, and observation The validity of the data using the triangulation method. The informants in this study were 16 people who had sufficient information about fraud in 3 hospitals, BPJS Health and the Palembang City Health Office. The results show that the potential for fraud in hospitals is related to the manipulation of diagnoses and/or actions, taking treatment actions that are not by medical indications, readmissions, fee contributions, and cases of service unbundling or fragmentation. Potential fraud occurs due to ineffective internal monitoring from hospital management and ineffective external monitoring from BPJS Health and the City Health Office. The conclusion of this study is to overcome the potential for fraud, internal cooperation between the Hospital, BPJS Health and related stakeholders is needed as stated in the Minister of Health Regulation No. 16 of 2019. Keywords: Fraud Potential, Management, Hospital, National Health Insurance Literature : 52 (2002-2022)

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Availability

Inventory Code	Barcode	Call Number	Location	Status
2307000183	T89389	T893892023	Central Library (Referens)	Available

Detail Information

Series Title

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Call Number

T893892023

Publisher

Palembang : Prodi Magister Ilmu Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat., 2023

Collation

xxii, 229 hlm.; ilus.; 29 cm

Language

Indonesia

ISBN/ISSN

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Classification

610,607

Content Type

Text

Media Type

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Carrier Type

-

Edition

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Subject(s)

Jurusan Ilmu Kesehatan Masyarakat
Organisasi dan Manajemen Kedokteran, JKN

Specific Detail Info

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Statement of Responsibility

MURZ

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