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    Synergy BPJS Health, KPK, and the Ministry of Health Fight Cheating


    BANDUNG-As the world's largest health insurance program organizer, one of the efforts that BPJS Health has always done is to prevent the potential of cheating alias fraud. According to Minister of Health Regulation no. 36 Year 2015, there are various parties that potentially commit fraud in the Health Insurance program National-Healthy Indonesia Card (JKN-KIS), ranging from participants, health facilities, to providers of drugs and medical devices. Therefore, BPJS Health committed to strengthen the synergy with the Government and Corruption Eradication Commission (KPK) by establishing a joint supervisory team.

    In his release, President Director of BPJS Health, Fahmi Idris said "The supervisor team consists of Coordinator, Working Group on Prevention of Cheating in JKN, Fraud Detection Working Group in JKN, and Working Group of Fraud Completion in JKN," he said after signing Joint Decree on Team Together with Fraud Management in JKN Program, together with Health Minister Nila F. Moeloek and KPK Chairman Agus Rahardjo, Wednesday (19/07).

    The Coordinator is tasked with reviewing the guidelines prepared by the Working Group, coordinating the arrangement and formulation of legislation, coordinating the implementation of the socialization of guidelines, piloting the implementation of guidelines and implementation of potentially fraudulent data analysis in JKN, and evaluating the progress of the performance of each Group Work.

    The Working Group on Prevention of Cheating in JKN is in charge of drafting the JKN Fraud Prevention Guidelines for health facilities, and coordinating the professionals/ experts and / or relevant agencies required in the preparation of the guidelines. The JKN Fraud Detection Working Group is in charge of drafting the Fraud Detection Guidelines in JKN that includes data exchange procedures, analyzing potentially fraudulent data in JKN, and conducting initial detection of potentially fraudulent data in JKN as the basis for piloting.

    The JKN Fraud Completion Working Group is responsible for drafting the Fraud Reduction Guidelines in JKN covering fraud levels, settlement procedures and sanctions to be implemented, and coordinating with relevant experts and / or agencies required for the preparation of fraud resolution guidelines in JKN.

    "The concept is that we are very focused on running good governance. BPJS Health does not run alone in managing the JKN-KIS program, but is overseen by many parties, ranging from the level of Internal Supervisory Unit (SPI), Supervisory Board, National Social Security Council (DJSN), Financial Services Authority (OJK), Financial Supervisory Board (Badan Pengawas Keuangan - CPC), up to KPK. Each year we are also audited by the Independent Public Accounting Firm and have been awarded 25 Unqualified predictions (WTP) if counted since PT Askes (Persero)," Fahmi said. (Pun)

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