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[Artikel – Sanctioning] KPK Tindak Tegas Pelaku Fraud Layanan Kesehatan Mulai 2018

KPK berrencana menindak pelaku fraud layanan kesehatan per Januari 2018. Sanksi ini sebenarnya merupakan teguran keras terhadap berbagai pihak yang seolah acuh tak acuh terhadap isu kecurangan Jaminan Kesehatan Nasional (JKN). Kementerian kesehatan maupun sektor penegak hukum dianggap KPK belum menjalankan fungsi pencegahan fraud dengan semestinya. Dampaknya, potensi fraud layanan kesehatan semakin besar tiap tahun dan mengancam keberlangsungan program JKN. Pada tahap awal ini, aktor potensial fraud yang disasar KPK adalah provider layanan kesehatan. Kelompok ini diduga paling besar menggunakan dana JKN dengan cara tidak wajar dibanding aktor potensial lainnya seperti pasien, BPJS Kesehatan, maupun pabrik farmasi dan obat.

Bagaimana detil proses rencana penindakan pelaku fraud oleh KPK per 2018? Saksikan video lengkap wawancara PKMK dengan Niken Ariyati, fungsional Direktorat Litbang KPK, via webinar pada 21 Maret 2017.

Teks:

Kapan tepatnya rencana penindakan bagi provider?

Penindakan serius kapan? Tergantung di lapangan. Sejak 2014 KPK menyuarakan JKN wajib dijaga keberlangsungannya termasuk dari potensi fraud dan kecurangan lainnya. KPK mendorong berbagai stakeholder untuk memperbaiki sistem. Mendorong Kementerian Kesehatan untuk memperbaiki regulasi serta BPJS Kesehatan untuk memperbaiki sistem dan kendali juga.

Atas rekomendasi KPK di tahun 2014, sebenarnya sudah mengumpulkan data-data pihak mana saja yang diduga memiliki potensi fraud, sayangnya data tersebut tidak ditindaklanjuti. Data makin besar, tahun 2015 ada sekitar 178.000 data dengan nilai 400 milyar yang terduga fraud. Ditunggu sampai akhir 2016, data melejit hingga 1 juta klaim. Asumsi dengan nilai yang sama, yaitu 2 Trilyunan. So, mau diapakan data ini? Plus jalan keluarnya.

Dari perspektif KPK, pencegahan yang baik itu penindakan, penindakan yang baik itu pencegahan, dua sisi. Tapi kita gak langsung serta merta. Tanpa ada KPK masuk, ada provider yang dilaporkan BPJS (Kesehatan, red.) (melakukan, red.) pemalsuan dokumen, penipuan, ke kejaksaan atau pihak hukum yang ada. Tanpa KPK pun, lama-lama akan masuk ke ranah hukum. Penindakan ini cepat atau lambat, mau gak mau, pasti akan lari kesitu, dimana ada kecurangan, pasti akan kesitu. Kami serius menggarap itu, tapi memang ada fasenya. Spesifik fraud di bidang kesehatan, di KPK tidak ada kompetensi teknis untuk hal itu.

Yang kami lakukan pertama kali, yaitu bidding dalam peraturan atau surat tugas bersama, antara BPJS Kesehatan, KPK, Kemenkes (inspektorat-inspektorat). Data-data yang sudah dikumpulkan BPJS Kesehatan kami analisis, definisi dan telaah kembali untuk audit yang lebih dalam atas data-data tersebut. Tapi sebelum itu, kita tetapkan aturannya.

Permenkes 36/2015 sudah ada tapi implementasi masih lemah. Banyak yang tidak clear. Jadi kita terapkan disitu, penindakannya seperti apa fraud untuk kesehatan. Kalau memang bukan korupsi, ada aparat penegak lain yang dapat menangani. Jika memang ada, bisa langsung ditindak. Jika tidak ada, mengapa mengada-ada. Nanti kita lihat, karena memang simpang siur, mana yang disebut fraud, upcoding ada intention atau tidak, phantom billing dan lain-lain. Mekanisme sanksi akan dibicarakan dalam bentuk pedoman.

Berarti dapat dikatakan, tahun 2018 nanti masih akan finalisasi pedoman sebelum dilakukan penindakan?

Data ada, tapi itu dari perspektif BPJS. Tidak hanya faskes yang melakukan fraud, namun bisa juga BPJS melakukan fraud saat mengetahui approval indikasi fraud maka bisa dituntut pasal 2, membantu dalam proses fraud. KPK di tengah saja, tidak serta merta di faskes. Jika BPJS tahu fraud dan tidak digagalkan, maka dapat diproses.

Mengolah data target 2017, April (2017, red.) tanda tangan, sepakati timnya. Agustus sepakati pedomannya. Agustus – Desember sosialisasi dan analisis data lalu turun ke lapangan dan koordinasi dengan asosiasi yang berkepentingan. Kurang lebihnya sama dengan yang disampaikan selama ini. Kalau memang ada masalah karena regulasi gak clear, akan jadi prioritas terakhir. Fraud karena adanya intention jelas, langsung tindak lanjuti saja. KPK dapat saja bekerja sama dengan aparat penegak hukum yang lain. Pedoman penindakan juga tidak milik KPK, tapi milik penegak hukum dalam mengawasi pelaksanaan JKN.

Berarti akan ada koordinasi dengan asosiasi?

Pasti ada, terutama kita paham clinical pathway di RS belum lengkap, banyak pertanyaan bundling, upcoding. Ibaratnya pakai SOP ini fraud, yang lain tidak. Maka kita clearkan yang abu-abu ini.

Kami tidak akan medahulukan penindakan. Kita setting sanksinya macam-macam, ada remidi program, administrasi, pidana dan perdata. Di remidi program, pengembalian dengan denda, berapa denda yang dikenakan kita bahas lagi. Secara badan, kita dorong integrity plan, dengan menerapkan pedoman anti fraud yang lebih baik.

Bagaimana gambaran kerja sama tim-tim yang sudah ada: satgas, tim pencegahan Kecurangan JKN tingkat nasional, maupun TKMKB tingkat nasional, dalam proses pencegahan hingga penindakan?

Nanti orang-orangnya kan itu-itu saja. (Saat ini, red.) banyak yang tidak kerja karena tidak ada aduan di level kabupaten. Intinya kurang efektif kami lihat. Kami ingin mendorong semua lini yang ada.

Sekiranya dengan dispute-dispute yang ada karena masalah regulasi, kita dorong tim kendali mutu biaya (untuk menentukan, red.) kebijakan apa yang kita ambil atas kondisi ini. Jika ada dugaan fraud dan lain-lain, satgas yang kami bentuk ini yang akan bekerja sambil meminta saran ahli, harus benar-benar adil dan benar keputusan yang dibuat. Kami tidak gegabah, pasti ada proses yang dijalani. Termasuk konsultasi dengan tim yang sudah ada, jika ada laporan di provinsi yang tidak diselesaikan, itu yang akan kami dorong. Mungkin tidak diikomunikasikan ke pusat, atau pusat ada agenda lain, itu yang kami dorong. Itu bagian kerja dari tim juga. Kita trigger mechanism saja, mana yang belum kita dorong. Jika ada masalah komunikasi, kita bantu komunikasikan.

Saat ini data potensi fraud yang diolah KPK berasal dari BPJS Kesehatan. Apakah ada rencana menaungi data semacam ini dengan skala yang lebih luas untuk deteksi potensi fraud dari aktor potensial lainnya?

Satgas yang kita bentuk, fokus saat ini untuk data klaim. Masalah obat, strategi KPK kita gunakan mekanisme lain, banyak penyedia obat yang wan prestasi, curang, tidak clear, menyalahi kontrak. Satgas yang kami bentuk ini untuk mekanisme klaim. Untuk aduan lain akan dibahas kemudian.

Misal untuk ranjang yang habis atau referral out, kami akan dorong pemerintah daerahnya. Perlu dilihat lagi, faskes di bawah apa, tingkat kabupaten kota atau di provinsi atau swasta. Jika di kabupaten kota, kita koordinasi dengan Pemda setempat. Jadi dia tau pelanggarannya apa dan tindak lanutnya apa.

Berarti memang ada rencana menindak semua pelaku kecurangan JKN?

Kita juga jalan pelan. Proses. Namun harus ada progress.

Apa saran KPK kepada provider sebagai pihak yang saat ini diduga melakukan kecurangan JKN?

Pertama itu integritas, sebenarnya ikuti aturan yang ada. Jangan jadikan untuk sarana keuntungan pribadi atau institusi, sebagai penerima uang cash. Sistem dibangun baru, bersama-sama, belum tentu layanan akan untung. Efisiensi ketika meningkatkan layanan penting sekali. Niat nakal itu sudahlah, terlihat kok mana yang ngawur. Ada lho, diagnosis mata tapi treatment ultrasound. Sudahlah tidak perlu aneh-aneh untuk meningkatkan income. Ini sistem pemerintah. BPJS Kesehatan klaim bayar 70 Trilyun. Saya sanksi di bisnis mana diguyur 70 ribu milyar terus rugi, ini kan sebenarnya gak mungkin. Intinya berintegritaslah sesuai aturan, jadikan sektor kesehatan sebagai layanan yang baik. Jujur sajalah dalam pelayanan.

Reporter: drg. Puti Aulia Rahma, MPH

 

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Also visit my site - seo packages pricing: https://lp-e--comexpert-ru.cdn.ampproject.org/c/s/lp.e-comexpert.ru/bitrix/redirect.php%3Fgoto%3Dhttps%3A//www.iatn.net/redirect%3Furl%3Dhttp%3A//oldwiki.bedlamtheatre.co.uk/index.php/Little_Known_Ways_To_Seo_Price_Packages_Safely
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# Adrianne 2022-11-23 09:59
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Feel free to visit my website ... Seo
Prices Uk: http://dseyeon.com/bbs/board.php?bo_table=free&wr_id=22008
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