PENERAPAN SANKSI ADMINISTRATIF TERHADAP RUMAH SAKIT PELAKU FRAUD KLAIM JKN DALAM PERSPEKTIF HUKUM KESEHATAN
DOI:
https://doi.org/10.55352/josh.v5i02.2659Keywords:
JKN fraud, Hospital Liability, Administrative SanctionsAbstract
Fraudulent claims in Indonesia’s National Health Insurance (JKN) pose a serious threat to financial sustainability and quality of healthcare services. Hospitals, as referral healthcare providers, are highly vulnerable to fraudulent practices such as upcoding, phantom billing, and diagnosis manipulation. This study analyzes the regulation and effectiveness of administrative sanctions imposed on hospitals committing JKN claim fraud from a health law perspective. Using a normative legal research method with statutory, conceptual, and case approaches, this study finds that although administrative sanctions are normatively regulated, their implementation remains ineffective in creating deterrence and legal certainty. Sanctions tend to be formalistic and weakly enforced due to limited supervision and inter-institutional coordination. Strengthening regulations, supervision systems, and sanction standards is therefore essential to ensure legal protection and sustainability of JKN
References
Guntoro, AS et al. Fraud pada Penagihan Klaim Jaminan Kesehatan Nasional. Uwais Inspirasi Indonesia. 2025. Hlm 1-20
Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Nomor 16 Tahun 2019 tentang Pencegahan dan Penanganan Kecurangan (Fraud) serta Pengenaan Sanksi Administrasi terhadap Kecurangan (Fraud) dalam Pelaksanaan Program Jaminan Kesehatan. 2019.
Kementerian Kesehatan Republik Indonesia. Surat Edaran Nomor HK.02.01/Menkes/1567/2024 Tentang Pelaksanaan Pencegahan, Penanganan, Dan Penerapan Sanksi Administratif Kecurangan (Fraud) Sebagai Upaya Kendali Mutu Dan Kendali Biaya Dalam Program Jaminan Kesehatan Di Fasilitas Pelayanan Kesehatan. 2024
Purnomo Purnomo, & Zainal Arifin Hosein. (2025). Effectiveness of Administrative Sanctions in Overcoming Fraud by Health Facilities on JKN Participants. Desentralisasi : Jurnal Hukum, Kebijakan Publik, Dan Pemerintahan, 2(1), 175–189. https://doi.org/10.62383/desentralisasi.v2i1.426
Inggi Putri Galuh, Achadi Anhari. Evaluation of Fraud Prevention Policies in the National Health Insurance System in Indonesia: Narrative Literature Review. Media Publikasi Promosi Kesehatan Indonesia (MPPKI) 7(10):2449-2457. DOI:10.56338/mppki.v7i10.6164
Fani VS, Suparno. Urgency of Regulatory Updates in Law Enforcement Against Fraudulent Acts by Health Facilities in the National Health Insurance Program. International Journal of Social Service and Research. Vol. 5, No. 7, July 2025. Page 724-731
Villegas-Ortega J., Bellido-Boza L., Mauricio D. Fourteen years of manifestations and factors of health insurance fraud, 2006–2020: a scoping review. National Library of Medicine. Health Justice. 2021 Sep 30;9:26. doi: 10.1186/s40352-021-00149-3
Andi Ashar. (2023). Aspek Yuridis Penerapan Sanksi Adminisratif Bagi Pelaku Kecurangan (FRAUD) Dalam Program Jaminan Kesehatan Nasional. JURNAL HUKUM, POLITIK DAN ILMU SOSIAL, 1(1), 156–161. https://doi.org/10.55606/jhpis.v1i1.1738
Dimas Wicaksono dan Nur Khasanah, “Penegakan Hukum terhadap Fraud Klaim Jaminan Kesehatan Nasional oleh Rumah Sakit,” Jurnal Hukum dan Etika Kesehatan 3, no. 2 (2022): 145–160,
https://jhek.hangtuah.ac.id/index.php/jurnal/article/view/243
Kementerian Kesehatan Republik Indonesia. Cegah Fraud, Kemenkes Bentuk Tim Pencegahan. 2024. https://kemkes.go.id/eng/cegah-fraud-kemenkes-bentuk-tim-pencegahan?utm. Diakses tanggal 4 Januari 2026
Untari, PH. Dewas Desak Fraud Rumah Sakit (RS) ke BPJS Kesehatan Ditangani Serius. 2024. https://finansial.bisnis.com/read/20240726/215/1785632/dewas-desak-fraud-rumah-sakit-rs-ke-bpjs-kesahatan-ditangani-serius?utm. Diakses tanggal 4 Januari 2026.
