Jember District Prosecutor's Office investigates alleged JKN claim corruption at several hospitals

Jember, East Java (ANTARA) - The Jember District Prosecutor’s Office is investigating a case of alleged corruption in JKN national health insurance fund claims at several hospitals in Jember Regency during the period from 2019 to 2025. “Investigators have also upgraded its status from preliminary inquiry to full investigation,” said the Head of the Jember District Prosecutor’s Office, Yadyn, during a press conference held at a Media Gathering in Jember on Thursday evening. According to him, the elevation of the status of the alleged corruption involving manipulation of BPJS Kesehatan claims by several hospitals in Jember followed a series of examinations in the preliminary stage and the collection of various documents. “The investigative team then conducted an exposure or case review and concluded that the alleged corruption through ‘fraud upcoding’ and/or ‘phantom billing’ by several hospitals from 2019 to 2025 should be elevated to the investigation stage,” he said. The fraud in the JKN programme consists of “phantom billing,” namely submitting claims for health services or medicines that were never actually provided to patients. “The deviations also involve ‘upcoding,’ namely manipulating diagnosis or procedure codes to make them more severe in order to obtain higher claims than they should,” he said. Yadyn stated that the status elevation is based on Sprint Dik: Print 658 / M.5.12/fd.2 / 05 / 2026 dated 7 May 2026, so several witnesses will be called by investigators to complete the case file. “Investigators have summoned 12 witnesses in this case,” he said. He explained that investigators will delve into the evidence to determine suspects, but regarding the losses in this case, calculations are still being carried out by the relevant agency, namely the Financial and Development Supervisory Agency (BPKP). Previously, the Head of BPJS Kesehatan Jember Branch, Yessy Novita, in a hearing with Commission D of the Jember Regency DPRD some time ago, mentioned that three hospitals in Jember Regency were suspected of committing fraud by manipulating (marking up) JKN programme claims. BPJS Kesehatan Jember has also issued written sanctions to the three hospitals that committed the fraud in accordance with the BPJS Kesehatan Board of Directors Regulation, and repayment of losses has been agreed upon according to the value of fraud found by BPJS Kesehatan officers.