Implementasi Pencegahan Kecurangan (Fraud) di Rumah Sakit Umum Daerah R. Syamsudin, S.H. Kota Sukabumi

Abstract

Healthcare fraud poses a systemic threat to the national health system's integrity. This study evaluates the effectiveness of fraud prevention at RSUD R. Syamsudin,S.H. through an analysis of anti-fraud policies, quality control, and organizational culture. Using a quantitative descriptive design, data were collected from 306 staff members via stratified random sampling. Results show a 96% system acceptance rate, with 23% of respondents rating it as "very good" and 73% as "good." Compliance with Clinical Practice Guidelines reached 95.8%, while integrity culture and safe reporting systems were positively rated by 95.4% and 93.5% of respondents, respectively. However, 31.4% of staff were unaware of specific written anti-fraud policies, highlighting a need for better information dissemination. No significant perception differences were found between direct and indirect service providers. In conclusion, fraud prevention implementation is effective but requires accelerated monitoring digitalization and continuous training to address future National Health Insurance (JKN) challenges.