BPJS Kesehatan Teams Up with KPK on Fraud Mitigation

TEMPO.CO, Depok -  The Health Care and Social Security Agency (BPJS Kesehatan) director, Fachmi Idris, explained that the agency had three responsibilities in regards to the policy mix carried out by the Ministry of Health for the sustainability of the national health insurance (JKN). They are fraud mitigation, the system of health treatment reference, and purchasing strategy.

“We have completed a discussion about fraud mitigation with the Health Ministry and the Corruption Eradication Commission (KPK),” said Fachmi at the University of Indonesia, Depok, Monday, September 9.

Fachmi explained that the fraud mitigation program, which is carried out in tandem with the ministry and the anti-graft body, would be passed in the form of Ministerial Regulation, given the potential fraud practices in the agency.

“[A potential practice of] fraud may not only be committed by a hospital but also insurance participants or BPJS workers,” he said.

The agency is also developing an online system of treatment reference. “We are cooperating with the Health Ministry about a policy that will stipulate more about the online reference system,” Fachmi added.

Additionally, the agency is improving its purchasing system by encouraging passive purchasers to become active ones. “This purchasing strategy is a vital issue.” 

Therefore, tariff adjustments and insurance benefits can play a better role. “Because then, we will know exactly how much money we have and how many cases we handle, that we have to maintain the balance,” he remarked.

Previously, Health Minister Nila Moeloek said the government would set a policy mix to assist BPJS Kesehatan that will be released through an amendment to the Presidential Regulation No. 12/2013 concerning national health insurance (JKN).

ADE RIDWAN