House wants ‘illegal’ hospital fees investigated

JAKARTA. The House of Representatives Commission IX overseeing manpower demanded that the Health Ministry take action against hospitals that charged exorbitant fees to patients covered by the national health insurance (JKN) program.

Commission member Zuber Safawi said the House had received various reports alleging foul play by hospitals when charging patients covered by the Social Security Management Agency for the Health Sector (BPJS Kesehatan). 

Zuber said that some of the hospitals had argued that extra fees were needed as the BPJS Kesehatan did not cover certain “rare” medicine.

Other hospitals also argued that they had been forced to provide health facilities to patients not covered by the government program.

“[The reasons] didn’t make any sense. The government should verify whether it’s true that certain types of medicine are scarce. Or was this strategy the brainchild of pharmaceutical companies?” he said Monday.

Zuber said that JKN had modified its reimbursement system, which was now called the Indonesia Case Based Groups (INA-CBGs) and replaced the former fee-for-service and commercial plans that were prone to over-charging patients.

The system, which is similar to an insurance package, was designed to ensure that all in-patient costs covered by BPJS Kesehatan included treatment, medicine and consultations.

“There should be no over-charging when hospitals use the INA-CBGs system,” he said.

Zuber demanded that BPJS Kesehatan inform all patients under its coverage to be aware of illegal charges applied by hospitals.

“BPJS Kesehatan should file a report to the police or the Health Ministry if it finds any fraudulent practices, so that the hospitals are punished,” he said.

Bayu Tedjamuliawan, pharmaceutical service director at the Health Ministry, said that the government had built a system connecting community health centers (Pukesmas), hospital pharmacies and regional health agencies, which would provide up to date information on the availability of medicine for the JKN program.

“Currently, the availability of medicine in every regency and city is 93 percent. Local drugstores also help meet demand,” he said.

BPJS Kesehatan spokesman Ikhsan told The Jakarta Post that daily monitoring of claim-filing by hospitals was underway. 

The agency also set up a special team to investigate possible fraud and abuse in the insurance system.

According to data provided by BPJS Kesehatan, by April 4, 30 out of the agency’s 1,502 partner hospitals had not filed any claims. This is a drop from 250 in February.

By the end of March, the agency had paid claims of Rp 1.98 trillion (US$173.1 million) for patients, while by the end of February, claims paid to hospitals, including down payments, hit Rp 1.14 trillion. (gda)