A Legal Review of the Authority of the JKN Fraud Prevention and Handling Team in Resolving Alleged Fraud Cases Under Ministry of Health Regulation No. 16 of 2019

Abstract

The implementation of the National Health Insurance (JKN) program involves various parties and complex processes, thereby carrying a risk of fraud. Fraud in the administration of JKN not only poses a risk of financial loss but can also impact accountability, service quality, and the program's sustainability. In this context, the JKN Fraud Prevention and Handling Team plays a crucial role in identifying, investigating, and addressing suspected fraud. This study aims to analyze the authority of the JKN Fraud Prevention and Handling Team in resolving suspected fraud cases pursuant to Minister of Health Regulation Number 16 of 2019, specifically regarding the scope and limits of authority, the status of investigation findings, and follow-up actions. The study employs a normative-juridical method utilizing statutory, conceptual, and analytical approaches. Legal materials were gathered through literature review, while analysis was conducted qualitatively using systematic and prescriptive interpretation. The findings indicate that the Team’s authority is administrative in nature and must be exercised within the limits prescribed by legislation. Indications of fraud cannot be immediately deemed conclusive evidence that fraud has occurred; thus, stages of verification, investigation, and clarification are required before determining follow-up actions. A distinction must also be made between the Team's investigative findings and the authority to impose administrative sanctions or enforce criminal law. Therefore, strengthening fraud-handling mechanisms should focus on clarifying the limits of authority, investigation procedures, coordination mechanisms, and legal accountability to ensure legal certainty and provide protection for the parties under investigation.