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North Sumatra Prosecutor’s Office investigates misuse of JKN funds by 40 hospitals
A team is currently gathering evidence and statements from several institutions suspected to have been involved in the graft, North Sumatra Prosecutor’s Office spokesperson Sumanggar Siagian said.
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A patient named Nurasiah, a resident of Medan Deli district, was reportedly told to pay Rp 25 million for a c-section surgery at Adam Malik Hospital in Medan, North Sumatra, and was not allowed to go home, even though she had provided her insurance card. (Shutterstock/File)
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he North Sumatra Prosecutor’s Office is investigating 40 hospitals and clinics in North Sumatra suspected of misappropriating national health insurance (JKN) funds since 2014, with each institution believed to have misused as much as Rp 5 billion (US$357,980).
A number of cases have been reported of patients complaining about having to pay for hospital services despite being covered by the insurance, which is run by the Health Care and Social Security Agency (BPJS Kesehatan).
A patient named Nurasiah, a resident of Medan Deli district, was reportedly told to pay Rp 25 million for a c-section surgery at Adam Malik Hospital in Medan and was not allowed to go home, even though she had provided her insurance card.
The case was widely reported and local councilors expressed support for the mother and newborn baby, resulting in the hospital allowing Nurasiah to go home after several days. However, her baby remained at the hospital after suffering head swelling.
The JKN has incurred a deficit since launching in 2014, with BPJS Kesehatan's deficit predicted to surpass Rp 28 trillion this year. The government has spotted early signs of inefficiency in hospitals lodging their claims.
A thorough review was recently conducted by the Health Ministry after the Development Finance Comptroller (BPKP) found discrepancies in claim payments to hospitals during the BPJS Kesehatan audit in 2018, including overpayment to C-level hospitals, which were paid at the same rates as B-level hospitals. A-level hospitals are those with the best resources, facilities, equipment and services.
The review resulted in the ministry’s decision last week to lower the status of 615 of the 2,170 state and private hospitals partnered with BPJS Kesehatan after they were found to be providing substandard services to patients.
