Legal Analysis Of Fraudulent Fictitious Claims (Phantom Billing) In The Implementation Of The National Health Insurance Program In Solo Raya

Authors

  • Setyarini Universitas Wisnuwardhana
  • Imam Ropii Universitas Wisnuwardhana
  • Carolina Kuntardjo Universitas Wisnuwardhana
  • Marsudi Dedi Putra Universitas Wisnuwardhana

DOI:

https://doi.org/10.38035/jlph.v6i5.3649

Keywords:

Fraud, claims, health insurance, Solo Raya

Abstract

This study aims to: (1) analyze the occurrence of fictitious claims (phantom billing) by healthcare providers in the implementation of the National Health Insurance (JKN) program in the Solo Raya region, and (2) examine the strategy of the Health Social Security Agency (BPJS Kesehatan) in preventing such fraud. This empirical legal study employs a socio-legal approach using primary and secondary data collected through interviews, document analysis, literature review, and website sources. The data were analyzed qualitatively and prescriptively. The findings indicate that phantom billing is mainly caused by weaknesses in the manual reporting system, limited supervision, and low integrity among certain healthcare personnel, compounded by financial pressures and delayed data verification. BPJS Kesehatan addresses these issues through digital transformation, including biometric authentication, integrated electronic medical records, stronger cross-sector coordination, enhanced internal verification, and continuous fraud prevention education to improve accountability and integrity in JKN services.

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Published

2026-08-12

How to Cite

Setyarini, Imam Ropii, Carolina Kuntardjo, & Marsudi Dedi Putra. (2026). Legal Analysis Of Fraudulent Fictitious Claims (Phantom Billing) In The Implementation Of The National Health Insurance Program In Solo Raya. Journal of Law, Politic and Humanities, 6(5), 4287–4299. https://doi.org/10.38035/jlph.v6i5.3649

Issue

Vol. 6 No. 5 (2026): (JLPH) Journal of Law, Politic and Humanities

Section

Articles

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Copyright (c) 2026 Setyarini, Imam Ropii, Carolina Kuntardjo, Marsudi Dedi Putra

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