Potential Fraud in The Primary Healthcare

Nizar Fathurrohman, Arlina Dewi

Abstract


This study discusses of potential fraud at the primary healthcare. Fraud is more often associated with secondary healthcare, namely hospitals, so that fraud in primary healthcare rarely supervises. Premi of JKN around 38.5 trillion and estimating the potential fraud of around 5% will disappear 1.8 trillion per year. This research used qualitative methods with phenomenological design, as the data are collected using in-depth interview and observation techniques. The number of respondents in this research were 3 public healthcare and 2 private healthcare in X regency. The results showed potential fraud in primary healthcare related to human resources (HR), management of health service, leadership policies, management of capitation funds and operational audits.


Keywords


Fraud; Primary Healthcare; Audit; Human Resource; Capitation;

Full Text:

PDF

References


Kementrian kesehatan R.I. (2013). Standar Tarif Pelayanan Kesehatan pada Fasilitas Kesehatan Tingkat Pertama dan Fasilitas Kesehatan Tingkat Lanjut dalam Penyelenggaraan Program Jaminan Kesehatan, Permenkes Nomor 69. Jakarta.

IHPP Thailand. (2011). Universal Health Coverage : Thailand Experience.

Maidin A, Palutturi S. (2016) Kajian Implementasi Jaminan Kesehatan Nasional Lintas Provinsi. Makasar :Universitas Hasanundin.

Bappenas. (2011). Peningkatan Akses Masyarakat terhadap Kesehatan yang Berkualitas.

Efendi, Ferry. (2009) Keperawatan Kesehatan Komunitas: Teori dan Prektek dalam Keperawatan. Jakarta: Salemba Medika.

Suhadi Sukri Palutturi, Muh Kardis Rais, Zainuddin, Alimin Maidin. (2014). Fraud Prevention In Implementation In National Health Insurance Kendari City. Indonesia. International Journal of Health and Medical Sciences. Kendal.

Kementrian kesehatan R.I. (2014). Standar Tarif Pelayanan Kesehatan Dalam Penyelenggaraaan Program Jaminan Kesehatan. Permenkes Nomor 59. Jakarta.

BPJS Kesehatan. Panduan Praktis

Gate Keeper Concept Faskes BPJS Kesehatan ; 2015

Morris. (2009) Health Insurance: The Journal of Risk and Insurance.

Albrecht, W. S., Hill, N. C., & Albrecht, C. C. (2006). The ethics development model applied to declining ethics in accounting. Australian Accounting Review, 16(1), 30-40

R Thanasak. (2013). Beyond the Fraud Diamond. International Journal of Management and Administrative Sciences, 2(1), pp.01-05.

Zafirah Rizka, Sutopo Patria Jati, S. B. (2018). Analisis Pencegahan Kecurangan dikota Semarang. Jurnal Kesehatan Masyarakat, 6, 95–104.

Wolfe, D., & D. R. Hermanson. (2004). The fraud diamond: Considering four elements of fraud. The CPA Journal, 74(12), 38-42.

Kementrian kesehatan R.I. (2015). Pencegahan Kecurangan (Fraud) Dalam Pelaksanaan Jaminan Sosial Nasional, Permenkes Nomor 36. Jakarta.

KPK. (2015). KPK Temukan 4 Kelemahan Pengelolaan Dana Kapitasi. Retrieved from https://www.kpk.go.id/id/berita/siaran-pers/2440-kpk-temukan-4-kelemahan-pengelolaan-dana-kapitasi

Rae, K., & Subramaniam, N. (2008). Quality of internal control procedures: Antecedents and moderating effect on organisational justice and employee fraud. Managerial Auditing Journal, 23(2), 104-124.

McClurg, L. A., & Butler, D. S. (2006). Workplace theft: A proposed model and research agenda. Southern Business Review, 31(2), 25-34

Holtfreter, K. (2004). Fraud in U.S. organisations: An examination of control mechanisms. Journal of Financial Crime, 12(1), 88-95.

BPJS Kesehatan. (2015). Panduan Praktis Pelayanan Kesehatan. Diakses 25 April 2016, dari http.//www.bpjs-kesehatan.go.id/semua-download.html.

Freshka. (2015). Analisis Kualitas Sumber Daya Manusia dan Pengaruhnya terhadap Pertumbuhan Ekonomi. Pelalawan. Jurnal Jom Fekon Vol.2 No.2.

Salamete, Rattu dan Pangemanan. (2014). Analisis Perencanaan Sumber Daya Manusia Kesehatan di Dinas Kesehatan Kabupaten Minahasa Tenggara. Minahasa Tenggara. Jurnal Ilmu Kesehatan Masyarakat Unsrat, Suplemen, Vol.4, No.4.

Mas’ud, Fuad. (2004). Survai Diagnosis Organisasional Konsep & Aplikasi. Badan Penerbit Universitas Dipenogoro. Semarang.

Hasan, A. G., & Adisasmito, W. B. B. (2017). ANALISIS KEBIJAKAN PEMANFAATAN DANA KAPITASI JKN PADA. Jurnal Kebijakan Kesehatan, 6(03), 127–137.

Futhoni, Renata Arianingtyas, Siti Aminah, Uli Parulian Sihombing. (2009). Memahami Diskriminasi. Buku Saku Kebebasan Beragama.

Liliweri, Alo. (2005). Prasangka & Konflik: Komunikasi Lintas Budaya Masyarakat Multikultural. Buku Penerbit LKiS.

Kementrian kesehatan R.I. (2014) Pusat Kesehatan Masyarakat. Permenkes Nomor 75. Jakarta.

Kementrian kesehatan R.I. (2014) Klinik. Permenkes Nomor 9. Jakarta.

Dorminey, J., Fleming, A., Kranacher, M., & Riley, R. (2010). Beyond the fraud triangle. The CPA Journal, 80(7), 17-23.

Jackson, K., Holland, D., Albrecht, C., & Woolstenhulme, D. (2010). Fraud isn’t just for big business: Understanding the drivers, consequences, and prevention of fraud in small business. Journal of International Management Studies, 5(1), 160-164.

Soleman. (2013) Pengaruh Pengandalian Internal dan Good Coporate Governance terhadap Pencegahan Fraud. JAAI Vol. 17 No.1.

Tuanakotta, Theodorus M. (2007). Akuntansi Forensik dan Audit Investigatif. Jakarta : Lembaga Penerbit Fakultas Ekonomi Universitas Indonesia.

Presiden R.I. (2014). Pengelolaan Dan Pemanfaatan Dana Kapitasi Jaminan Kesehatan Nasional Pada Fasilitas Kesehatan Tingkat Pertama Milik Pemerintah Daerah. Perpres Nomor 32. Jakarta.

Trisnawati, Nugroho dan Wanto. (2014). Pengaruh Implementasi Sistem Pengadaan Secara Elektronik (E-Procurement) terhadap Fraud pengadaan Barang/ jasa Pemerintah. Jurnal Administrasi Publik (JAP), Vol.3 No.1

Setiaji, Tomi Kostantia. (2015). Analisis Faktor Internal Dan Eksternal Sebagai Bahan Penyusun Strategi Pencegahan Fraud Dana Kapitasi Puskesmas Di Kota Semarang. Semarang. JKM eJournal FKM Undip, Vol.3 No.3

Nasharuddin Baidan& Erwati Aziz. (2014). Etika islam dalam Berbisnis, Yogyakarta. Pustaka Pelajar. h. 127

Fullerton, Rosemary R & Cindy Durtschi. (2004). The Effect of Professional Skepticism on The Fraud Detection Skills of Internal Auditors. Working Paper Series. Utah State University.

Divianto. (2012). Peranan Audit Operasional terhadap Efektivitas Pelayanan Kesehatan Rawat Inap di Rumah Sakit. Jurnal Ekonomi dan Informasi Akuntansi, Vol.2 No.2

Wardhini. (2010). Peranan Audit Internal dalam Pencegahan Kecurangan. Skripsi. Sarjana Ekonomi, Universitas Widyatama.




DOI: https://doi.org/10.18196/jmmr.7373

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit)

Office:
Ruang Jurnal JMMR, Gedung Pascasarjana Universitas Muhammadiyah Yogyakarta
Brawijaya Street, Tamantirto, Kasihan, Bantul, D.I. Yogyakarta, Indonesia
email: jmmr@umy.ac.id

Creative Commons License
JMMR is licensed under Creative Commons Attribution 4.0 International License.

View My Stats

View My Stats (back up)