Health Care Fraud : Health Service Capitation

Muhammad Akbar, Tarjo Tarjo

Abstract


This study aims to analyze the risk of fraud against the National Health Insurance Capitation fund management system in the BLUD of the Pesisir Regency Government. This research is a qualitative research with a case study approach. Data were obtained through in-depth interviews, observation and documentation studies. The results showed that the risk of fraud in the National Health Insurance capitation fund management system at the Pesisir District Government Health Center occurred because of the weak JKN capitation fund management system that was not in accordance with regulations so that it could disrupt health services, weak internal control due to no supervision from the Health Service and the Inspectorate, no normal management of JKN capitation funds, and pressure from the work environment.

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