REPUBLIC OF INDONESIA STATE NEWS

No. 739, 2015 FRANKKES. Health insurance program. SJSN. Fraud. Prevention.

REGULATION OF THE REPUBLIC OF INDONESIA HEALTH MINISTER NUMBER 36 YEARS 2015

ABOUT THE FRAUD PREVENTION (FRAUD) IN THE IMPLEMENTATION OF THE PROGRAM

HEALTH CARE ON THE NATIONAL SOCIAL SECURITY SYSTEM

WITH GRACE GOD ALMIGHTY HEALTH MINISTER OF THE REPUBLIC OF INDONESIA,

DRAWS: A. That at the host of health care programs in the national social security system was found to be a variety of issues including potential fraud (Fraud) that could cause harm to the national social security fund;

b. that the loss of health care funds due to Cheating (Fraud) needs to be prevented with the national policy of prevention of Cheating (Fraud) in order to carry out national health guarantee programs in the national social security system can be running effectively and efesien;

c. that based on consideration as in letter a and letter b, need to establish a Health Minister Regulation on the Prevention of Cheating (Fraud) in the Implementation Of The Warranty Program Health on the National Social Security System;

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Given: 1. Law No. 31 Year 1999 on Eradication Of Criminal Corruption (State Of The Republic Of Indonesia In 1999 Number 140, Additional Gazette of the Republic of Indonesia Number 3874) as amended by Law No. 20 2001 (sheet State Of The Republic Of Indonesia In 2001 Number 134, Additional Gazette Of The Republic Of Indonesia Number 4150);

2. Law Number 17 Year 2003 on State Finance (Indonesian Republic of Indonesia Year 2003 Number 47, Additional Gazette of the Republic of Indonesia Number 4286);

3. Law No. 1 of 2004 on the State Treasury (State Gazette Indonesia Year 2004 No. 5, Additional Gazette of the Republic of Indonesia Number 4355);

4. Law No. 15 Year 2004 on Examination of Management And Responsibilities of State Finance (State Gazette Indonesia Year 2004 Number 66, Additional Gazette Republic of Indonesia Number 4400);

5. Act Number 29 of 2004 on the Practice of Medicine (Indonesian Republic of Indonesia Year 2004 Number 116, Additional Gazette of the Republic of Indonesia Number 4431);

6. Law No. 40 of 2004 on the National Social Security System (Indonesian Republic of Indonesia Year 2004 Number 150, Additional Gazette of the Republic of Indonesia Number 4456);

7. Law No. 36 Year 2009 on Health (State Gazette of Indonesia Year 2009 Number 144, Additional Gazette Republic of Indonesia States No. 5063);

8. Law No. 44 Year 2009 on Hospital (Indonesian Republic of Indonesia Year 2009 Number 153, Additional Gazette of the Republic of Indonesia Number 5072);

9. Act No. 24 of 2011 on the Social Security Organizing Board (State Sheet of the Republic of Indonesia of 2011 Number 116,

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Additional Republic Of Indonesia State Sheet Number 5256);

10. Law Number 23 Year 2014 on Local Government (sheet of State of Republic of Indonesia 2014 No. 244, Additional Gazette Republic of Indonesia Number 5587);

11. Law Number 36 Year 2014 on Health Power (Indonesian Republic of Indonesia Year 2014 Number 298, Additional Gazette Republic of Indonesia Number 5607);

12. Government Regulation No. 49 Year 2013 on the Supervising Board of the Hospital (State Sheet of the Republic of Indonesia Year 2013 Number 111);

13. 2013 Presidential Decree Number 12 Year 2013 on Health Guarantee (State Sheet of the Republic of Indonesia Year 2013 Number 29) as amended by Presidential Regulation No. 111 of 2013 (State Gazette Indonesia Year 2013 Number 255);

14. The Presidential Decree No. 32 of 2014 on Management And Utilization Of the National Health Assurance Capitation Fund At First-level Health Facilities Of The Local Government (sheet Of State Of The Republic Of Indonesia Year 2014 Number 81);

15. Ministry of Health No. 755 /Menkes/Per/IV/2011 about the Medik Committee at the Hospital (2011 Republic of Indonesia State News No. 259);

16. Ministry of Health Regulation No. 71 of 2013 on National Health Guarantee Guidelines (State News of the Republic of Indonesia 2013 No. 1400);

17. Ministry of Health Regulation Number 9 Year 2014 about the Clintons (State News of the Republic of Indonesia 2014 Number 232);

18. Ministry of Health Regulation No. 10 of 2014 on the Board of Trusts of the Hospital (State News of the Republic of Indonesia 2014 Number 360);

19. Health Minister Regulation Number 14 Of 2014 On The Gratification Control In The Environment

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Ministry of Health (State News of the Republic of Indonesia 2014 Number 416);

20. Regulation of Health Minister Number 19 of 2014 on the Management of National Health Assurance Capitation Fund for Health Service Services and Operational Cost Support at the Local Government ' s First Level Health Facility (State News) Republic of Indonesia in 2014 No. 589);

21. Ministry of Health Regulation No. 27 of 2014 on Technical Guidance of the Indonesian Case Base Groups (INA-CBGs) (State News of the Republic of Indonesia 2014 No. 795);

22. Ministry of Health Regulation No. 28 of 2014 on the National Health Care Act 2014 Guidelines 874;

23. Ministry of Health Regulation No. 59 of 2014 on the Standards of Health Care Rate in the implementation of the Health Assurance Program (State News of the Republic of Indonesia 2014 Number 1287);

24. Regulation of Health Minister Number 75 of 2014 on the Center for Public Persons (News of the Republic of Indonesia 2014 Number 1676);

DECIDED:

Establishing: HEALTH MINISTER REGULATIONS ON FRAUD PREVENTION (FRAUD) IN THE COURSE OF THE HEALTH INSURANCE PROGRAM ON THE NATIONAL SOCIAL SECURITY SYSTEM.

BAB I

provisions of UMUM Article 1

In this Minister Regulation, which is referred to by: 1. Cheating (Fraud) in the implementation of the Health Guarantee Program

on the National Social Security System which is next called JKN Cheating is an action done intentionally by participants, BPJS Health officers, givers health care services, as well as drug providers and health tools to benefit financial benefits from the health assurance program in the National Social Security System through fraudulent deeds that do not comply with the provisions.

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2. The next Health Guarantee Claim called a Claim is a health care fee payment request by a health facility to the Health Social Security Organizing Board.

3. BPJS Health's next Social Security Organizing Agency is a legal entity that is set up to host a health assurance program.

4. The First Health Care Facility (FKTP) is a health facility that performs non-specialistic individual services for observation, diagnosis, treatment, treatment, and/or health care. Others include first-degree outpatient and first-degree hospitalization.

5. Advanced Referral Health Facility (FKRTL) is a health facility that performs a specialized or subspecific individual service that includes advanced outpatient, hospitable-level operations. follow-up, and outpatient in a special care room.

6. Episodes are the health care process given to patients ranging from incoming patients to patients out of health facilities, including consultation and examination of doctors, support checks, and other checks.

7. The Government of the Central Government is the President of the Republic of Indonesia, which holds the power of government of the Republic of Indonesia which is assisted by the Vice President and ministers as referred to in the Basic Law of the State Republic of Indonesia in 1945.

8. The Regional Government is the regional head as an organizer of the Regional Government, which leads the implementation of government affairs which are the authority of autonomous regions.

9. Minister is the Minister who organizes government affairs in the field of health.

BAB II

ACTS OF CHEATING JKN Article 2

The JKN Cheating may be performed by:

a. participants; b. BPJS Health officer;

c. health care provider; and/or d. drug providers and health tools.

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Article 3 of the JKN Cheating Acts performed by the participants as referred to in Article 2 of the letter a, includes: a. making untrue statements in terms of eligibility

(falsifying the status of the membership) to obtain health services;

b. utilize its right to unneccesary services (unneccesary services) by falsifying health conditions;

c. giving catification to the service provider to be willing to provide unsuitable service.

d. Manipulating the income so as not to pay the dues is too big;

e. doing cooperation with the service provider to submit a false Claim;

f. obtaining medication and/or healthcare tools prescribed for resale; and/or

g. Other JKN Cheating actions other than the letters a up to the letter f.

Section 4

The JKN Cheating Actions performed by BPJS Healthcare officers as referred to in Section 2 of the letter b, include:

a. conduct cooperation with participants and/or healthcare facilities to submit a false Claim;

b. Manipulating benefits that should not be guaranteed to be guaranteed;

c. withholding payment to a health/partner facility with the goal of obtaining a personal gain;

d. Pay the capitation funds not in accordance with the provisions; and/or e. perform other JKN Cheating actions in addition to the letter a until

with the letter d. Article 5

(1) The JKN Cheating Act performed by the health care provider as referred to in Article 2 of the letter c is performed at:

a. FKTP; and b. FKRTL.

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(2) JKN Cheating acts performed by health care providers in FKTP as referred to in paragraph (1) letter a, include: a. utilize the capitation fund not in accordance with the provisions

the laws of the negotiations;

b. Manipulating the Claim on a non-capitation paid service;

c. received a commission on referrals to FKRTL; d. attracting fees from participants who should have been guaranteed in

the cost of capitation and/or noncapitation according to the specified tariff standard;

e. perform patient referrals that are not appropriate for the purpose of obtaining a particular advantage; and/or

f. Other JKN Cheating actions other than letters a up to the letter e.

(3) JKN Cheating Actions conducted at FKRTL as referred to in paragraph (1) letter b, include: a. overwriting of the overt diagnosis code/upcoding; b. The taming of the claim of another patient/cloning; c. false claim/phantom billing; d. drug bills bubble and alkes/inflated bills; e. breaking of service episodes/services unbundling or

fragmentation; f. Your semu/selfs-referals; g. repeated bills/repeat billing; h. extended a long treatment/ length of length of stay; i. manipulate the treatment class/type of room charge; j. cancelled the mandatory action/cancelled services; k. conducting unneeded action/no medical value; l. deviation to standard service/standard of care; m. performing unnecessary treatment actions/unnecessary

treatment; n. add a length of ventilator usage time; o. not performing the supposed visitation/phantom visit;

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p. does not perform the supposed procedures/phantom procedures; q. repetitive admission/readmission;

r. perform patient referrals that are not appropriate for the purpose of acquiring a particular advantage;

s. ask for cost sharing not in accordance with the provisions of the laws of the law; and

t. Other JKN Cheating actions other than the letters a up to the letter s.

(4) excessive diagnosis code/upcoding as referred to in paragraph (3) the letter is a modification of the diagnosis code and/or procedure into a code that has a higher tariff than it should be.

(5) The definition of a Claim from another patient/cloning as referred to in paragraph (3) of the letter b is a claim made by copying from the Claim of another patient already.

(6) The false claim/phantom billing as contemplated in the verse (3) the letter c is a Claim for a service that is never given.

(7) The drug bill and the alcase/inflated bills as referred to in paragraph (3) the letter d is a claim on the cost of the drug and/or the health tool greater than the actual cost.

(8) The breaking of the episode service/services unbundling or fragmentation as referred to in paragraph (3) the letter e is a Claim for two or more diagnoses and/or procedures that should be a single service package in the same Episode or charged a few separate procedures that should be charged together in the form of a service package, to get a greater Claim value in one patient's treatment episode.

(9) Your semu/selfs-referals as referred to in paragraph (3) the letter f is a Claim for a service charge due to the reference to the same doctor at the facility Other health except for facility reasons.

(10) Repeal bills/repeat billing as referred to in paragraph (3) the letter g is a Claim repeated in the same case.

(11) Extended the length of the treatment/ length of stay as referred to in paragraph (3) the letter h is a Claim for a charge $(12) Manipulating the treatment class/type of room charge as referred to in paragraph (3) the letter i is a Claim for the cost

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greater health care of actual care class charges.

(13) Canceling mandatory action/cancelled services as referred to in paragraph (3) the letter j is Claims for diagnosis and/or actions that are not implemented.

(14) Conduct unnecessarily/no medical value as referred to in paragraph (3) the letter k is a Claim for an action not based on a need or Medical indications.

(15) Deviation against standard service/standard of care as referred to in paragraph (3) the letter l is a Claim for diagnosis and/or action that does not conform to the standard of service.

(16) Conduct unnecessary treatment/unnecessary treatment as Referred to in paragraph (3) the letter m is a Claim for an unrequisite action.

(17) The length of the ventilator usage length as referred to in paragraph (3) the letter n is a greater Claim due to the old addition the use of a ventilator that does not fit the need.

(18) Did not perform The supposed visitation/phantom visit as referred to in paragraph (3) the letter o is a Claim for a false patient visit.

(19) Did not perform the supposed procedure/phantom procedures as referred to in paragraph (3) A p is a Claim for an act that is never performed.

(20) A repeating mission/readmission as referred to in paragraph (3) the letter q is a Claim for the diagnosis and/or action of one Episode that is cared for or claimed more than one time as if more than one Episode.

Article 6

JKN cheating actions performed by drug providers and health tools as referred to in Article 2 of the d letters include:

a. not to meet the needs of the drug and/or the health care tool in accordance with the provisions of the laws of the law;

b. Conduct cooperation with other parties changing the drug and/or the health tools listed in the e-catalog at the price of not corresponding to e-catalog; and

c. performing other JKN Cheating actions other than letters a and letter b.

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CHAPTER III FRAUD PREVENTION

Section of General Affairs

Section 7

In the implementation of the Health Guarantee Program in the National Social Security System, BPJS Healthcare, Health Service The District/City, and FKRTL that team up with BPJS, must establish the JKN Cheating prevention system.

The Second Section

The Prevention of JKN Cheating at BPJS Health Article 8

BPJS Health must establish a JKN Cheating prevention system through:

a. Drafting of the JKN Cheating policy and prevention guidelines at BPJS healthcare;

b. JKN Cheating prevention culture development as part of a good organization governance; and

c. formation of JKN Cheating prevention team at BPJS Healthcare.

Third Section of the JKN Cheating Prevention at FKTP

Article 9

The County/City Health Service must build a JKN Cheating prevention system in FKTP through:

a. Preparation for the JKN Prevention policies and guidelines; b. Control of health care oriented to control

quality and cost control; and c. development of JKN Cheating prevention culture as part

of good clinical governance and clinical governance.

Article 10 (1) The policy and prevention guidelines of JKN Cheating as to

referred to in Article 9 of the letter a, should be able to organize and encourage all human resources at FKTP working according to ethics, professional standards, and service standards.

(2) The substance of the JKN Cheating policy and prevention guidelines as referred to in paragraph (1) includes setting up to

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applied and its application procedures include behavioral and disciplinary standards, monitoring and evaluation ensuring compliance of execution, as well as the application of sanctions against its customers.

Article 11

(1) In order for the development of health care oriented to quality control and cost control as referred to in Article 9 of the letter b, the County/City Health Service must form the JKN Cheating Prevention Team in FKTP.

(2) The JKN Cheating Prevention Team in FKTP as referred to in paragraph (1) consists of a health service element, a profession organization, BPJS Health, and a health facility association.

(3) The health service as referred to in paragraph (2) in forming the JKN Cheating Prevention team at FKTP may involve other related elements.

(4) The JKN Cheating Prevention Team in FKTP as referred to in paragraph (2) is in charge:

a. Socializing new policies, guidelines, and culture are oriented toward quality control and cost control;

b. encourage the execution of organizational governance and good clinical governance;

c. conduct preventive, detection and suppression efforts of JKN Cheating in FKTP;

d. The JKN Cheating dispute; e. monitoring and evaluation; and

f. Reporting. Section 12

(1) FKTP must conduct JKN Cheating Prevention efforts against all claims submitted to BPJS healthcare.

(2) JKN Cheating prevention efforts at FKTP as referred to in paragraph (1) are performed in a manner: a. an increase in the ability of doctors and other relevant officers

with a Claim; and b. increased management in the Cheating Early Detection Effort

JKN.

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Fourth Section of the JKN Cheating Prevention at FKRTL

Paragraph 1 of the JKN Cheating Prevention System

Article 13

(1) FKRTL that in cooperation with BPJS Health must build a preventive system JKN's cheating through:

a. The JKN Cheating (JKN) policy and prevention guidelines;

b. the development of health care oriented toward quality control and cost control; and

c. development of JKN Cheating prevention culture as part of organizational governance and control of clinical governance quality and cost control.

(2) The JKN Cheating prevention system in FKRTL in cooperation with BPJS Health as referred to in paragraph (1) includes the JKN Cheating prevention system at:

a. the hospital; and b. The primary or equivalent clinic.

Article 14 (1) The policy and prevention guidelines of JKN Cheating as

referred to in Article 13 of the letter a is a part of the internal FKRTL regulation, which is technically described in the form of the system manage organizations and good clinical governance.

(2) The policy and prevention guidelines of JKN Cheating should be able to organize and drive the entire human resources of FKRTL to work according to ethics, standards of the profession, and service standards.

(3) The substance of the policy and prevention guidelines The JKN as referred to in paragraph (1) consists of arrangements that want to be applied and its application procedures include behavioral and disciplinary standards, monitoring and evaluation that ensure compliance with execution, and the application of the sanctions of its customers.

Section 15

(1) Quality control oriented health care and cost control as referred to in Section 13 of the paragraph letter b is done through:

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a. the use of effective and efficient management concepts; b. the use of evidence-based information technology; and

c. formation of the JKN Cheating Prevention team at FKRTL. (2) Evidence-based information technology as referred to in paragraph

(1) letter b should be able to monitor and evaluate all activities at FKRTL efficiently and measurably.

Article 16

(1) Development of the Cheat Prevention Culture JKN as part of the organization's governance as referred to in Article 13 of the letter c is based on principle:

a. transparency; b. accountability;

c. Responsibilities; d. independence; and

e. It's a natural. (2) Transparency as referred to in paragraph (1) the letter a

is the disclosure of information, either in the process of decision making and in revealing information that is appropriate to the need for prevention of JKN Cheating.

(3) Accountability as referred to in paragraph (1) letter b is the clarity of the system structure function and the accountability of the service so that the management is effective.

(4) Responsibility as referred to in paragraph (1) the letter c is the suitability or compliance in the management of services against the principles of a healthy organization in the prevention of JKN Cheating Prevention.

(5) Independencies as referred to in paragraph (1) the d is a state where an organization is professionally managed without a clash of interests and influence or pressure from any party that does not conform to the principles of the law. A healthy organization in the prevention of JKN Cheating.

(6) The header as referred to in paragraph (1) letter e is a fair and equal treatment in meeting the rights of stakeholders arising under the agreement in order of the JKN Cheating Prevention.

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Article 17 (1) The development of the JKN Cheating prevention culture as part

of the clinic Governance as referred to in Article 13 of the letter c is done through:

a. correctness of the competencies and of the health care authority;

b. the application of service standards, clinical service guidelines, and clinical pathways;

c. clinical audits; and d. Claim procedure.

(2) The clinical governance of the clinic as referred to in paragraph (1) is performed in accordance with the provisions of the laws.

Paragraph 2

JKN Fraud Prevention Team at FKRTL Article 18

(1) The JKN Cheating Prevention Team in FKRTL consists of an internal search unit element, medik committee, medical recorders, Koder, and other related elements.

(2) The JKN Cheating Prevention Team in FKRTL as referred to in paragraph (1) is on duty:

a. doing early detection of JKN Cheating based on health care claim data was conducted by FKRTL;

b. Socializing new policy, regulation, and culture is oriented toward quality control and cost control;

c. encourages the execution of organizational governance and good clinical governance;

d. enhance Koder ' s ability, as well as doctors and other officers related to the Claim;

e. conduct the prevention, detection and suppression efforts of JKN (JKN) Cheating;

f. monitoring and evaluation; and g. reporting.

(3) To execute the tasks referred to in paragraph (1), the JKN Cheating Prevention Team at FKRTL is coordinating with BPJS Health both regularly and at any time.

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Article 19 In terms of primary clinic or equivalent health facility yet to have a JKN Cheating Prevention team, JKN Cheating prevention can be carried out by JKN fraud prevention team at FKTP formed by State/City Health Service.

Paragraph 3 Of JKN Fraud Prevention Activities at FKRTL

Section 20 (1) FKRTL must conduct early detection and detection efforts

JKN Cheating against all claims submitted to BPJS Healthcare.

(2) Efforts The prevention of JKN Cheating in FKRTL as referred to in paragraph (1) is done in a way: a. increased Koder skills, doctors, as well as other officers who

related to the Claim; and b. increased management in the Cheating Early Detection Effort

JKN.

(3) The JKN Cheating early detection attempt at FKRTL as referred to in paragraph (1) is exercised through activities:

a. Claim Data Analysis; investigation; and

c. reporting results analysis of the Claims data and the JKN Cheating investigation.

Section 21

(1) The increased Koder capability in the Cheating of the JKN Cheating efforts as referred to in Article 20 of the verse (2) is the least of a: a. identification of important factors or enhancing accuracy

koding to prevent errors;

b. education about the knowledge of JKN Cheating; c. training and education education is correct;

d. Koder ' s workload adjustment with the amount of power and of its competitors; and

e. enhance interaction with clinical staff in order to ensure primary and secondary diagnostics.

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(2) Improving the ability of physicians as well as other officers with respect to the Claim in a JKN Cheating effort, as referred to in Article 20 of the most letters of the letter: a. the understanding and use of the applicable coding system;

b. conduct education and understanding of the JKN Prevention and prevention measures;

c. increased obedience to operational procedure standards; and

d. write and provide a clear, complete and timely medical resume.

(3) The increased management of health facilities in the JKN Cheating efforts is referred to in Article 20 paragraph (2) the least b of the letter: a. the reinforcement of the Koder task as a companion verifier,

an investigator, and an internal auditor on an internal examination unit specifically for the audit of the claim;

b. conducting data surveyors or routine data audits;

c. use of software for the prevention of JKN Cheating;

d. create a clinical practice guide on each type of service by implementing the clinical pathway.

e. Form a team of education to patients and health care.

f. create effective procedures and procedures and control policies to block, prevent, know, report, and correct the potential of JKN Cheating.

Section 22

(1) The analysis of the Claim data in the JKN Cheating early detection effort as referred to in Article 20 paragraph (3) of the letter is performed routinely by JKN Cheating Prevention Teams.

(2) The analysis of the Claim data as referred to in paragraph (1) is conducted via the approach technique:

a. seeking data anomalies; b. predictive modeling; and

c. discovery of the case.

(3) The analysis of the Claim data in FKRTL as referred to in paragraph (2) is done manually and/or by leveraged the clinical verification application integrated with the INA-CBGs application.

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(4) In conducting a data analysis of the Claim as referred to in paragraph (1), JKN Cheating Prevention team can coordinate with verificator or other necessary parties.

Article 23

(1) An investigation into the early detection of JKN Cheating as referred to in Article 20 of the letter b is made to ensure that there is an alleged JKN Cheating, an explanation of the events, and the background/reason.

(2) Investigations as referred to in paragraph (1) are carried out by an investigative team appointed by the JKN Cheating Prevention Team by engaging expert elements, hospital associations/health facilities associations, and profession organizations.

(3) In carrying out its duties, the investigating team as referred to in paragraph (2) may conduct an audit.

Article 24 (1) The detection and investigation of the alleged Cheating

JKN as referred to in Article 20 of the paragraph (3) The letter c is performed by the JKN Cheating Prevention Team to the facility leadership health.

(2) Reporting as referred to paragraph (1) at least contains:

a. there is or is the occurrence of the JKN Cheating incident found;

b. The recommendations for prevention of a similar event are similar in the later days; and

c. the administrative sanction recommendations for the JKN Cheating. Fifth Part

Section 25

(1) Any person who learns of the JKN Cheating Act may be written in writing.

(2) The complaint as referred to in paragraph (1) delivered to the leadership of the health facility, the County Health Service/City and/or the Provincial Health Service.

(3) The complaint as referred to the paragraph (1) should contain at least a: a. identity of the complain;

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b. name and address of the instance which is suspected of the actions of JKN Cheating; and

c. the reason for the complaint. Section 26

(1) The leadership of the health facility, the County/City Health Service and/or the Provincial Health Service must follow up on the complaint as referred to in Section 25 by conducting an investigation.

(2) Investigations as referred to in paragraph (1) performed by involving BPJS Health, the JKN Cheating Prevention Team at FKRTL, or the JKN FKTP Cheating Prevention Team formed the District Health/City Health Service.

(3) The leadership of the health facility, the County/City Health Service and/or the Provincial Health Service after conducting an investigation as referred to in paragraph (1) must establish there is no JKN Cheating Act of action.

(4) In the event of an opinion dispute regarding the designation of no JKN Cheating as referred to in paragraph (3), the Provincial Health Service or the District Health Service/City may continue its complaint to the Prevention Team. JKN fraud formed by the Minister

BAB IV

COACHING AND SUPERVISION of section 27

(1) The coaching and supervision of JKN Cheating Prevention was carried out by the Minister, the Head of the Provincial Health Service, and the Head of the Health Service District/City corresponds to each other's authority.

(2) In terms of coaching and The supervision, as referred to in a verse (1) is conducted in the hospital, may involve hospital supervisors, hospital supervisors, labor associations, and professions of the profession.

(3) In terms of coaching and supervision as referred to in paragraph (1) performed at the primary or equivalent clinic and FKTP, may involve the association of health facilities and the profession organization.

(4) The coaching and supervision as referred to in paragraph (1) is exercised through: a. advocacy, socialization, and technical guidance;

b. training and increased human resource capacity; and

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c. monitoring and evaluation. BAB V

ADMINISTRATIVE SANCTION Section 28

(1) In order for the coaching and supervision of the Minister, Head of Provincial Health Service, Head of the District Health Service/City may provide administrative sanctions for the health, power facilities health, and health care providers and tools.

(2) administrative sanctions as referred to in paragraph (1) are:

a. oral reprimand;

b. written reprimand; and/or c. command of return loss due to JKN Cheating to

the aggrieved party. (3) In the event of JKN Cheating actions done by the giver

service or drug provider and health tool, the administrative sanction as referred to in paragraph (2) may be coupled with the most fine of 50% of the return amount The loss caused by the JKN Cheating Act.

(4) In terms of JKN Cheating actions performed by healthcare, the administrative sanction as referred to in paragraph (3) may be followed by the revocation of the practice permit.

(5) the administrative sanction as referred to in paragraph (2) do not remove criminal sanctions in accordance with the provisions of the laws.

Article 29 (1) In terms of JKN Cheating actions carried out by BPJS officers

Health, Minister, Provincial Health Service Chief, and District Health Service Head/City issued a recommendation to BPJS to provide sanctions Administrative to the BPJS Health Officer performing JKN Cheating.

(2) The recommendation as referred to in paragraph (1) may be:

a. Oral reprimand; b. a written reprimand;

c. termination of the post;

d. dismissal; and/or e. loss of JKN Cheating loss command to

aggrieved party

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CHAPTER VI TRANSITIONAL PROVISIONS

Section 30 (1) Head of the District/City Health Service, director/head of the house

is ill, responsible for primary or equivalent clinics, health facilities associations, and organizations The profession must be socialized.

(2) The Head of the District Health Service/City Director/head of the hospital and the responsibility of the main clinic or equivalent should make the JKN Cheat Prevention System at least 6 (six) months since The rules of the Minister are promulred.

(3) In the event of JKN Cheating during The socialization and manufacture of the JKN Cheating Prevention System as referred to in paragraph (1) and verse (2), the administrative sanction as referred to in Article 28 cannot be imposed.

BAB VII

PROVISIONS OF THE COVER

Article 31 of the Regulation of the Minister comes into effect on the date of the promulcity.

For everyone to know it, order the invitation of the Regulation of the Minister with its placement in the News of the Republic of Indonesia.

Set in Jakarta on 30 April 2015 MINISTER OF HEALTH OF REPUBLIC OF INDONESIA, NILA FARID MOELOEK

Was promulred in Jakarta on 25 May 2015 MINISTER OF LAW AND HUMAN RIGHTS REPUBLIC OF INDONESIA, YASONNA H. LAOLY

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