<![CDATA[BPJS Kesehatan claims are a major source of hospital revenue under Indonesia's National Health Insurance (JKN) program, yet discrepancies between the value of claims submitted and the value verified by BPJS Kesehatan remain common. Such discrepancies may affect receivables management and the reliability of hospital financial statements. This study aims to analyze the causes of BPJS claim discrepancies, evaluate the effectiveness of internal control over BPJS receivables, examine auditors' responses to these discrepancies, and assess their implications for the fairness of financial statements. This research employed a descriptive qualitative approach at ABC Hospital, a type-B hospital audited by a public accounting firm in Indonesia. Data were collected through semi-structured interviews with the external auditor and hospital management, documentation review of audit working papers and verification reports (BAHV), and observation during the audit process. The results indicate that claim discrepancies are caused by errors in diagnosis and procedure coding, incomplete supporting documents, pending claims, and differences in interpretation during the verification process. Internal control weaknesses were identified in receivables reconciliation, claim documentation, information communication, and interdepartmental coordination, reflecting gaps in the COSO internal control framework. In response, auditors applied document tracing, reconciliation procedures, and re-performance testing—consistent with professional auditing standards on risk assessment and audit evidence—to ensure the reasonableness of receivable balances. Unresolved claim discrepancies may affect the presentation of receivables, revenue recognition, and the overall reliability of hospital financial statements, underscoring the need for stronger internal control and more consistent reconciliation practices.]]>
