KPK finds phantom billing at some hospitals

The Corruption Eradication Commission (KPK) plans to launch a massive audit in all hospitals associated with the National Health Insurance (JKN) program after finding indications of phantom billing in several healthcare facilities. KPK deputy for graft prevention Pahala Nainggolan said that the anti-graft body found that three out of six hospitals examined had allegedly made false claims related to JKN that resulted in state losses of Rp 35 billion (US$2.15 million)  “After auditing JKN claims [in the hospitals] between 2017-2018, we found that a hospital in Central Java committed fraud amounting to Rp 29 billion, while two hospitals in North Sumatera made false claims of Rp 4 billion and Rp 1 billion,” Pahala said on Wednesday as reported by Tempo. He went on to say that out of 4,341 claims made by the three hospitals, only 1,072 or 24 percent of them were supported by medical records. The hospitals, Pahala further explained, are allegedly engaged in three common fraudulent practices: claiming policyholders received more treatment than they actually did, raising treatment costs and creating phony policyholders to claim payments.

The money then went into the hospitals’ bank accounts, Pahala claimed, adding that hospital owners and doctors were allegedly involved in the illegal activity.
The KPK investigators have reported their findings to their leaders, who will later decide whether the agency is going to conduct further investigations or transfer the case to the Attorney General’s Office (AGO) instead.  Meanwhile, in the next six months, the KPK along with the health ministry, the Development Finance Comptroller (BPKP) and BPJS Kesehatan – which manages the JKN program – are planning to conduct a massive audit of all reimbursement claims. Health Ministry Inspector General Murti Utami said they would impose administrative sanctions or even revoke medical licenses of doctors found to be involved in the JKN insurance fraud. 

BPJS Kesehatan has suffered from major deficits for most of its 10 years in existence. Last year, it received Rp 151.4 trillion in premiums, but paid reimbursement claims of Rp 158.8 trillion. As of May, some 271 out of 270 million Indonesians are enrolled in the JKN program. (nal)