Indonesia Strengthens Anti-Fraud Measures in Healthcare Following International Best Practices

Learning from Malaysia and China

Indonesia is taking significant steps to combat fraud in its national health insurance (JKN) program by studying and implementing international best practices, particularly from Malaysia and China. The country is leveraging technology, strengthening regulatory frameworks, and enhancing inter-agency collaboration to protect the integrity of its healthcare system.

Malaysia's Approach to Fraud Prevention

Malaysia's social security organization, Pertubuhan Keselamatan Sosial (Perkeso), has been cited as a model for effective fraud prevention. Perkeso utilizes a combination of advanced data analytics and thorough investigation processes to identify and prevent fraudulent claims. Their anti-fraud division is centralized in Kuala Lumpur and works closely with other agencies, including the Malaysian Anti-Corruption Commission (SPRM).

In October 2024, Perkeso and SPRM successfully uncovered a significant fraud case involving six doctors in Penang, demonstrating the effectiveness of their collaborative approach. Perkeso is also exploring the potential implementation of whistleblower incentives, although this requires careful consideration and coordination with relevant authorities.

China's Strict Measures Against Healthcare Fraud

China has implemented stringent measures to combat healthcare fraud, including administrative and social sanctions. The Healthcare Security Administration (HSA) of Guangxi Zhuang Autonomous Region has outlined a multi-faceted approach that includes:1. Warning and demerit system for hospitals2. Revocation of medical licenses for practitioners3. Public disclosure of fraudulent entities4. Financial penalties up to five times the amount defrauded5. Criminal prosecution for severe cases

These measures aim to create a significant deterrent effect against potential fraudsters, ensuring the integrity of China's healthcare system.

Indonesia's Implementation of Anti-Fraud Measures

BPJS Kesehatan, Indonesia's health insurance agency, has been actively working to prevent and detect fraud within the JKN program. Between January and October 2025, the agency detected Rp6.8 trillion in fraudulent activities, with Rp5.1 trillion prevented and Rp1.7 trillion handled. The most common types of fraud identified include phantom billing and document manipulation.

To combat fraud, BPJS Kesehatan is:1. Enhancing data analytics capabilities2. Strengthening collaboration with law enforcement agencies3. Implementing stricter verification processes4. Considering individual sanctions against fraudulent practitioners

The agency is also working to balance fraud prevention with the need to maintain access to healthcare services for participants, particularly in regions with limited healthcare facilities.

Government Commitment to Anti-Fraud Efforts

The Indonesian government has emphasized its commitment to eradicating fraud in the JKN program. Minister Abdul Muhaimin Iskandar stressed that fraud in healthcare is not only a financial issue but also a moral and constitutional violation. The government plans to:1. Establish regional anti-fraud forums2. Strengthen professional ethics in healthcare3. Implement firm legal action against fraudsters

These measures aim to protect the integrity of the JKN program and ensure that resources are used effectively to provide quality healthcare services to the population.