Fraud Prevention Strengthened Amid Surge in Medical Costs
Prudential Indonesia has strengthened its commitment to health insurance fraud prevention through the Risk Awareness Series 2026, held amid rising medical costs and increasingly complex fraud schemes in health insurance claims.
The event, themed “Health Fraud in Indonesia – Modus Operandi and Prevention”, took place both in-person at Prudential Tower Jakarta and online via Zoom, with over 350 participants from staff and sales personnel.
Vikas Sinha, Vice President Director of Prudential Indonesia, stated that health insurance fraud poses a serious threat due to its impact on customer trust and industry resilience.
“Health insurance fraud is an issue that not only causes financial losses but also directly affects customer trust, ultimately weakening societal financial inclusion and resilience in the long term,” Sinha said.
He added that enhancing anti-fraud literacy and risk awareness culture is crucial for maintaining good corporate governance and industry sustainability.
Medical Inflation
Prudential noted medical inflation in Indonesia for 2025 could reach up to 19%, increasing pressure on the health insurance industry and potential fraud in claims.
Hery Subowo, Chair of the Board of Directors of ACFE Indonesia Chapter, highlighted that health insurance fraud schemes are becoming more diverse, including diagnosis manipulation, repeated claims, and identity misuse.
“Fraud prevention strategies can be implemented through a combination of strengthened manual processes such as verification, audit, and thorough claim validation, alongside IT-based technologies like data analytics, AI, and real-time monitoring,” Subowo said.
Meanwhile, Vetty Yulianty Permanasari, Director of HR and General Affairs at BPJS Kesehatan, said fraud challenges also exist within the national health insurance system.
She noted common fraud types include claims for services not provided, excessive use of medicines and medical devices, and claim duplication.
“Fraud prevention efforts are conducted comprehensively through risk management strengthening, human resource capacity building, partner compliance, and data-driven detection systems,” she added.
Prasetyo Edi, Chairman of the Indonesian Medical Ethics Council, emphasised the importance of professional ethics in preventing healthcare fraud.
He stated that medical professionals’ integrity and adherence to professional standards are key to ensuring medical procedures are based on patients’ clinical needs.
AI Technology Integration
As part of strengthening oversight systems, Prudential Indonesia has integrated artificial intelligence (AI), automation, and data analytics into claims processing. The company also offers the PRUServices platform to enhance transparency and ease of access to claims services for customers.
Maria Rosalinda, Director of Compliance and Risk Management at Prudential Indonesia, said collaboration among all stakeholders is necessary to build a clean and sustainable health insurance ecosystem.
“This synergy is a crucial foundation for continuously building a clean, sustainable, and trustworthy health insurance ecosystem for the Indonesian people,” Maria said.