REKONTRUKSI MODEL HUKUM PENCEGAHAN KECURANGAN (FRAUD) DALAM PENYELENGGARAAN SISTEM ASURANSI KESEHATAN NASIONAL DI INDONESIA

SUKMA, DARA PUSTIKA (2019) REKONTRUKSI MODEL HUKUM PENCEGAHAN KECURANGAN (FRAUD) DALAM PENYELENGGARAAN SISTEM ASURANSI KESEHATAN NASIONAL DI INDONESIA. PhD thesis, Universitas Sebelas Maret.

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    Abstract

    ABSTRACT DARA PUSTIKA SUKMA. T311508005. THE MODEL LAW THE PREVENTION OF FRAUD IN THE NATIONAL HEALTH INSURANCE SYSTEM IN INDONESIA. Promoter: Prof. Dr. Adi Sulistiyono, Sh., MH., Co Promoter: Dr. Tresno Novianto, Widodo. Sh., MHum. Dissertation. The Program Doctor Of Law Faculty Of Law Sebelas Maret University Surakarta. The purpose of this Dissertation is to find out and analyze: (1) why is there a diversion or Fraud in the National Health insurance system. (2) how the Model Law in preventing Irregularities or Fraud in the National Health insurance system. The methods used in the research of this thesis are non doctrinal or empirical research, using the concept of the fifth law, namely the law is the manifestation of the symbolic meanings of social actors as it looks in the interactions between them. This research is the research of Prescriptive, i.e. to know, review, and assess whether there is a suboptimal handling of Fraud in the National Health insurance system in Indonesia and get advice about What to do to resolve a problem that occurs in the Organization of the national health insurance system. The results showed that (1) in general the potential-potential Fraud health care increasingly appear to be in Indonesia. This potential appears and can be progressively expanded in general due to pressure from the new financing system prevailing in Indonesia, there is a chance because of the minimal scrutiny, and there is a justification when performing this action. In Indonesia the potential Fraud from a group of clinicians may appear due to; underpaid medical personnel, there is an imbalance between health service systems and health care burden, the service provider has not given adequate incentives, medical equipment supply shortages, inefficiency in the system, lack of transparency in health facilities, and cultural factors; (2) the Model Law in the prevention of fraud in the Organization of the national health insurance system is the sanctions made to crack down on the perpetrators of the Fraud. Based Permenkes 36 Years 2015 Number of prevention of Fraud (Fraud) in National health coverage on a National Social Security System (SJSN), a party is entitled to give the sanctions was the Minister, head of the provincial health Office, and head of Department Health District/City. The recommended sanctions in Permenkes is the administrative sanction in the form of: an oral reprimand; a written reprimand; and/or commands return loss due to Cheating JKN to the wronged. The results of this research are expected to give insights into the description of potential Fraud health care services to the parties responsible for the eradication of Fraud attempts such as the Ministry of health, District Health Office/city, ranks the Board of Directors of hospitals, the Agency and the Council of pengaws hospitals, Health professional organizations, BPJS, Association of health facilities, to local governments. These findings are also expected to bring various stakeholders that Fraud Crackdown must run in cycles, ranging from the development of consciousness – reporting – detection – investigations – sanctions – the development of consciousness. More parties is expected to mutually cooperate in health insurance Fraud Crackdown in Indonesia. Keywords: Prevention, Fraud, National Health Insurance

    Item Type: Thesis (PhD)
    Subjects: K Law > K Law (General)
    Divisions: Pascasarjana
    Pascasarjana > Doktor > Ilmu Hukum - S3
    Depositing User: Aren Dwipa
    Date Deposited: 28 Mar 2019 10:24
    Last Modified: 28 Mar 2019 10:24
    URI: https://eprints.uns.ac.id/id/eprint/43435

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