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BPJS Kesehatan has app to track hospital fraud
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Director of health insurance firm PT Askes Sri Endang Tidarwati shows a health insurance card in Jakarta, recently. (JP/-)
T
he Health Care and Social Security Agency (BPJS Kesehatan) now has an application to detect fraudulent claims by hospitals seeking larger reimbursement funds from the agency.
“The application named PIN-F will now scan claims sent by hospitals,” Togar Siagalla, head of the BPJS Kesehatan’s research and development team, said Thursday.
Hospitals will send a claim for reimbursement to the agency every month as health care fees of BPJS members. Then, the agency will process the claim and reimburse the expenses.
Furthermore, the PIN-F application would help the agency detect false medical treatments and procedures. For example, a doctor performed minor surgery on a patient with a minor injury but the claim stated major surgery was performed, Togar said.
The BPJS Kesehatan has a team in every province to detect suspicious claims, consisting of medical experts to consult whether a particular treatment was necessary for a patient. If such actions are considered false, reimbursement is denied and the hospital in question will be required to explain.
The application has been in existence since 2014. (wnd/bbn)
