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Komitmen PERSI Cegah Kecurangan JKN di RS

PERSI berkunjung ke kantor KPK pada Senin, 13 Maret 2017. Pernyataan dukungan terhadap rencana KPK menindak pelaku fraud pada 2018 menjadi agenda utama kunjungan ini. Pertemuan menghasilkan rencana tindak lanjut berupa penyusunan pedoman teknis pencegahan kecurangan JKN di rumah sakit (RS).

PKMK mewawancarai ketua PERSI, dr. Kuntjoro Adi Purjanto, M.Kes, untuk menggali lebih dalam strategi PERSI mempersiapkan RS membangun sistem pencegahan kecurangan JKN.

Teks:

Apa agenda besar PERSI berkunjung ke KPK pada 13 Maret 2017?

Tentu ini skenario strategis untuk tentu bagaimana fraud itu dieliminasi sedemikian rupa di RS yang melakukan kontrak dengan BPJS. Pertemuan itu, sekaligus pernyataan sikap PERSI untuk bersama-sama melakukan perbaikan fraud di RS. Pertemuan kemarin untuk deklarasi, kita punya komitmen yang sama, pernyataan sikap itu, kita menghendaki satu pengumuman rinci yang mudah dipahami semua RS, yang mulai tertarik kontrak dengan BPJS. Sementara interakasi di RS banyak masalah. Ini berpotensi bisa kesalahan disengaja, bisa tidak. Kami sedang menyusun tim, pedoman itu nantinya segera secepat mungkin akan disampaikan ke tim fraud, BPJS (Kesehatan, red.), KPK dan Kemkes. Harusnya bulan ini, ini tidak mudah harus berkomunikasi dengan profesi.

Siapa saja Perwakilan PERSI yang hadir dalam pertemuan tersebut?

Perwakilan yang hadir adalah pengurus harian: Prof. Budi Sampurno (Kompartemen Hukum dan Advokasi), dr. Daniel dan dr. Tonang (Kompartemen Jaminan Kesehatan), dr. Heru (Kompartemen Organisasi), Jendral Harjanto (Kompartemen Manajemen Klinik), perwakilan RS yang kita anggap dia merasakan sendiri, apakah 10 yang dianggap fraud (benar-benar, red.) terjadi, dr. Hananto (Direktur RS Jantung Harapan Kita), dr. Yudi (Direktur Pelayanan Medik RS Tarakan, Jakarta), dr. Masyudi (Direktur RS Sultan Agung Semarang, Ketua Mukisi).

Apa gambaran besar isi pedoman teknis pencegahan fraud yang akan disusun?

Fraud ala RS didefinisikan kembali, industri RS di Indonesia berbeda, tempat dan geografisnya. Di satu sisi ada hal pasien yang harus diselamatkan, kasus per kasus, sumber daya RS di Indonesia tidak sama, maka harus diatur. Termasuk definisi kita lihat bersama-sama.

Pedoman tersebut direncanakan selesai bulan ini, sudah melibatkan siapa saja dalam proses penyusunannya?

Sambil jalan kita berbicara dengan beberapa profesi, dengan yang paling banyak, nanti apa yang sudah disusun nanti dibahasakan sama dulu di dalam. Harapan saya si saling mengisi, bagi yang kasus dianggap potensi. Kami berharap melibatkan PERSI meski di Permenkes 36 ada internal investigasi, jangan terus loncat. PERSI tidak bisa menindak, ini PR untuk kita di daerah untuk dapat melakukan pelatihan. Penting untuk pelatihan investigasi ini.

KPK berencana melakukan penindakan pada tahun 2018. Dalam masa 9 bulan kedepan harapan Bapak selaku Ketua PERSI terhadap RS agar fraud tidak berkembang?

Kita patuh pada Permenkes No. 36/ 2015. Potensi fraud dieliminiasi dengan membangun sistem dan meningkatkan kemampuan cegah fraud. Mulai dari SOP jelas, pedoman praktek klinik berlaku baik.

Permenkes sudah terbit sejak April 2015, apa yang sudah dilakukan PERSI sebagai bentuk pembinaan ke RS anggotanya?

Mensosialisasikan Permenkes No. 36/ 2015 melalui website. Itu (materi-materi tentang Permenkes No. 36/ 2015, red.) sudah menjadi menu wajib bahwa kegiatan sifatnya nasional, kami menambahkan materi pokok seperti stop TB, resistensi antibiotik disamping patient safety dan akreditasi. Wujudnya dalam poster, seminar dan lain-lain.

Apa kendala RS dalam memenuhi Permenkes No. 36/ 2015?

Banyak hal. Perangkat hukum ada, SDM terbatas. Bingung nih, SDM sedikit, harus ada komite keselamatan pasien. Ndak perlu seperti itu, ketika SDM sudah berpihak (terhadap upaya pencegahan fraud, red.) gak perlu seperti itu. Shareholder dan stakeholder harus paham hal itu.

Berarti ini terkait penerapam hospital by laws?

Kami memiliki komitmen sama dengan Pak Soetoto (Ketua KARS, red.), pedoman hospital by law terlalu kuno. Kompartemen hukum media dan advokasi menyiapkan pedoman dan peraturan untuk disodorkan ke Kemenkes untuk mengubah hal itu.

Pesan Bapak untuk seluruh RS untuk menghadapi rencana KPK menindak pelaku fraud?

Untuk RS seluruh Indonesia, selain PERSI berusaha melakukan perubahan agar tidak terjadi orang yang tidak melakukan fraud dianggap melakukan dan potensi fraud menjadi tereliminasi, maka pertama please mulai dari kebijakan. Aplikasi aturan SOP, lakukan dengan benar. Pakai pedoman saat ini, Permenkes No. 36/2015. Jangan merasa fraud tidak ada, potensi tetap ada. Ketika kita tidak melakukan adaptasi, maka kita dianggap melakukan fraud. Sistemnya dulu dibangun.

Reporter: drg. Puti Aulia Rahma, MPH (This email address is being protected from spambots. You need JavaScript enabled to view it.)

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