Record Medical as Function Administration Prevention Fraud in Home Health Financing Sick
Keywords:
Medical Records, Administrative Functions, Fraud Prevention, HospitalAbstract
Medical records are an obligation that must exist in hospitals, both private and government hospitals, as confirmed in Republic of Indonesia Law Number: 17 of 2023 concerning health in Article 173 (c) for every Health Service Facility, it is mandatory to maintain medical records which is regulated by the Indonesian Minister of Health Regulation Number 24 of 2024 concerning Electronic Medical Records which replaces the Indonesian Minister of Health Regulation Number 269/Menkes/Per/III/2008 concerning Medical Records. This research uses a normative juridical approach carried out through collecting secondary data sourced from statutory regulations, jurisprudence, government policy documents, scientific journal articles, books and other sources related to the research subject. Based on its function, medical records are a requirement for complete administration of medical record documents in BPJS Health financing. In its implementation, it is unavoidable that there will be fraud due to incorrect, false or falsified medical record data. Poor (incomplete) medical record documentation will give rise to the potential for fraud. For example, incomplete and accurate documentation of diagnoses and medical procedures will give rise to opportunities for assigning inappropriate diagnosis and treatment codes. Inaccuracy in determining the code will encourage certain individuals to manipulate the code so that the claim submitted has a higher value. This is of course a form of fraud. For this reason, in order to avoid fraud and potential violations of criminal law, hospital management must equip its staff with the ability to be very thorough in verifying patient BPJS data to avoid administrative errors that can lead to legal proceedings.
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