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p-Index From 2021 - 2026
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All Journal Journal of Law, Poliitic and Humanities
Carolina Kuntardjo
Universitas Wisnuwardhana
Humanities Law, Crime, Criminology & Criminal Justice Social Sciences

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Legal Analysis Of Fraudulent Fictitious Claims (Phantom Billing) In The Implementation Of The National Health Insurance Program In Solo Raya Setyarini; Imam Ropii; Carolina Kuntardjo; Marsudi Dedi Putra
Journal of Law, Politic and Humanities Vol. 6 No. 5 (2026): (JLPH) Journal of Law, Politic and Humanities
Publisher : Dinasti Research

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/jlph.v6i5.3649

Abstract

This study aims to: (1) analyze the occurrence of fictitious claims (phantom billing) by healthcare providers in the implementation of the National Health Insurance (JKN) program in the Solo Raya region, and (2) examine the strategy of the Health Social Security Agency (BPJS Kesehatan) in preventing such fraud. This empirical legal study employs a socio-legal approach using primary and secondary data collected through interviews, document analysis, literature review, and website sources. The data were analyzed qualitatively and prescriptively. The findings indicate that phantom billing is mainly caused by weaknesses in the manual reporting system, limited supervision, and low integrity among certain healthcare personnel, compounded by financial pressures and delayed data verification. BPJS Kesehatan addresses these issues through digital transformation, including biometric authentication, integrated electronic medical records, stronger cross-sector coordination, enhanced internal verification, and continuous fraud prevention education to improve accountability and integrity in JKN services.
Co-Authors Imam Ropii Marsudi Dedi Putra Setyarini