FADHILA, Mona (2022) Peran Dokter Dalam Fraud Di Era JKN (Jaminan Kesehatan Nasional) Di Rumah Sakit Umum Daerah Banyumas. Masters thesis, Universitas Jenderal Soedirman.

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Abstract

Fraud indication if there is an element that is not in accordance with the provisions, an element of intent, harming other parties and bringing personal benefits. Doctors in their work serving patients are always guided by service standards (SOP) that refer to applicable laws and regulations. Fraud in the JKN Era seemed to be aimed at doctors, even though doctors were supervised at work by various parties. The KPK even detected potential fraud by doctors. Research on hospital, fraud in Indonesia concluded that healthcare fraud does exist. The Corruption Eradication Commission (KPK) has detected potential fraud committed by groups of doctors. There has not been a single study on the role of doctors in fraud in the JKN era in hospitals. Existing research is usually fraud in hospitals, not doctors. The purpose of this study was to determine the knowledge of doctors about fraud, the role of doctors in fraud in the JKN era at Banyumas Regional Hospital, the role of managers in monitoring and preventing fraud, the role of the fraud team in fraud control at Banyumas Hospital. This research method with mixed method,qualitative with quantitative data. The research informants consisted of 32 specialist doctors serving inpatient BPJS patients at Banyumas Hospital, 5 managers and 9 fraud teams at Banyumas Hospital. The results of the study found 3 acts of fraud, Pseudo Referrals or Self Refferals, Deviations from service standards / Standard of care and Phantom visits. But after analyzing using Indication of Fraud, the three acts of fraud found in this study can be categorized as non-fraud.

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