SYSTEM FOR DETECTION OF NATIONAL HEALTHCARE INSURANCE FRAUD BASED ON COMPUTER APPLICATION
| Autor: | Budi Santoso, Julita Hendrartini, Bambang Udji Djoko Rianto, Laksono Trisnantoro |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: | |
| Zdroj: | Public Health of Indonesia, Vol 4, Iss 2, Pp 46-56 (2018) |
| Druh dokumentu: | article |
| ISSN: | 2528-1542 2477-1570 |
| DOI: | 10.36685/phi.v4i2.199 |
| Popis: | Background: The national healthcare insurance (JKN) has been in deficit since 2014-2016; one of the causes is fraud inpatient hospital service. Objective: This study aimed to analyze the validity, reliability and effectiveness of detection system of national healthcare insurance fraud based on computer application in hospital. Methods: Cross-sectional method was used. Fraud data were collected at one episode in the inpatient JKN participant service. Results: Validity was assessed by Fischer exact test. The interpretation was done by hospital internal verification officer and BPJS Kesehatan verification officer. There were only 2 out of 1.106 services claims were different, resulted in p-value < 0.01. Reliability was assessed using Human Organization Technology Benefit questionnaire filled by admission administrator officer, BPJS Kesehatan officer and hospital internal verification officer; and then analyzed using Stata® software resulting in Cronbach's alpha value of > 0.8. Effectiveness was assessed by reducing potential fraud, conducted by RSUP dr. Soeradji Tirtonegoro from May until July 2017, which on May 2018 there were 8 findings, June 1 finding, and on July 2018 had no finding. Conclusion: System for detection of national healthcare insurance fraud based on computer application is valid, reliable and effective to be implemented in inpatient service in hospital. |
| Databáze: | Directory of Open Access Journals |
| Externí odkaz: |
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