Prudential Indonesia Steps Up Fraud Prevention Amid Rising Complexity
Prudential Indonesia has stepped up efforts to anticipate increasingly complex fraud schemes in the domestic health insurance industry.
Vice President Director Vikas Sinha stated that Indonesia’s health insurance industry is projected to continue growing due to relatively low inclusion rates, but faces increasingly complex challenges.
The challenges, he added in a statement in Jakarta on Wednesday, include the involvement of multiple parties in the healthcare ecosystem, significantly increasing the risk of insurance claim fraud.
He said health insurance fraud not only causes financial losses but also directly impacts customer trust, ultimately weakening public financial inclusion and resilience in the long term.
“Fraud management is no longer merely about compliance; it is a core pillar of industry sustainability,” he said.
To this end, the company has taken proactive steps to strengthen good corporate governance and protect customer interests through its annual Risk Awareness Series 2026 programme.
The initiative aims to enhance anti-fraud literacy, reinforce risk awareness culture, and affirm Prudential Indonesia’s commitment to conducting business with integrity and sound governance.
Hery Subowo, Chair of the Board of Directors of ACFE Indonesia Chapter, cited the 2025 Indonesia Fraud Survey revealing diverse fraud trends in health claims, such as diagnosis manipulation, repeated claim submissions, and identity misuse.
He urged the industry to adopt preventive measures without delay.
Fraud prevention strategies can be implemented through a combination of strengthened manual processes like verification, auditing, and thorough claim validation, alongside IT-based technologies including data analytics, AI, and real-time monitoring to detect unusual patterns early.
Meanwhile, BPJS Kesehatan’s Director of Human Resources and General Affairs Vetty Yulianty Permanasari noted fraud trends within BPJS Kesehatan, including claims for services not rendered, excessive use of medications or medical equipment, and claim plagiarism.
“Fraud prevention efforts are comprehensive, involving strengthened risk management, human resource capacity building, partner compliance, and data-driven detection systems to identify and address potential fraud early,” she said.
Vikas added that the company has enhanced fraud detection by integrating AI, automation, and data analytics into claim management processes.
Maria Rosalinda, Prudential Indonesia’s Director of Compliance and Risk Management, stressed that the Risk Awareness Series 2026 aims to ensure all employees have aligned understanding and vigilance to recognise and mitigate potential fraud early.
“This is a crucial foundation for building a clean, sustainable, and trusted health insurance ecosystem for the Indonesian people,” she said.