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All Journal Indonesian Journal of Health Community
Amabi, Maria Sumiati
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Health Professions

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Penggunaan Finger Print Sebagai Upaya Pencegahan Fraud Dalam Penjaminan Pasien Pengguna JKN : Studi Kasus Di RSIA X Kota Kupang Amabi, Maria Sumiati; Arumsari, Wahyuni; Marchamah, Dwi Nur Siti
Indonesian Journal of Health Community Vol 5 No 2 (2024): Volume 5 No 2 Tahun 2024
Publisher : Universitas Ivet

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31331/ijheco.v5i2.3437

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.
Evaluasi Penggunaan Fingerprint Sebagai Upaya Pencegahan Fraud Pada Peserta BPJS Rawat Jalan Di RSIA X Kupang Amabi, Maria Sumiati; Marchamah, Dwi Nur Siti; Arumsari, Wahyuni
Indonesian Journal of Health Community Vol 6 No 2 (2025): Volume 6 Nomor 2 Tahun 2025
Publisher : Universitas Ivet

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31331/ijheco.v6i2.3788

Abstract

Since the National Health Insurance program was launched, BPJS Kesehatan has faced many challenges, one of which is the potential for fraud. BPJS has collaborated to develop fingerprint innovations by implementing a digitalization process for eligibility assurance. The purpose of this study was to review the effectiveness of fingerprint use as a fraud prevention effort in outpatient BPJS participant services at RSIA X Kupang. The research method was qualitative with interviews, observation, and documentation. The study was conducted from October to December 2024. A review of the implementation of fingerprint use in outpatient BPJS patient services at RSIA X showed a significant decrease in potential fraud cases compared to the previous year, when fingerprints were not implemented. The percentage of potential fraud patients who came for outpatient treatment using another participant's BPJS participant card in 2024 experienced a significant decrease, where out of a total of 14,817 outpatients in 2024, there were 2 patients, or equal to 0.01% who had the potential for fraud. The evaluation process must be carried out correctly and precisely to maximize the quality of service in the use of fingerprints.
Co-Authors Nur Siti Marchamah, Dwi Wahyuni Arumsari