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Health Service Fraud in the midst of Coronavirus and Auditors as Fraud “Doctors” in Indonesia

Written by: Kamila Pramaputri

Designed by: Muhammad Farhan Fajarmukti

The main duty of an auditor is to evaluate internal control of an organization and conduct compliance tests. Compliance test is an audit that must determine whether the organization is following its policies or procedures in a particular area. During this test, auditors must validate the evidence. The common activities used for compliance tests are asking the employees and observing the employees when they conduct their duties, also reviewing the documents to see whether the procedures are being followed or not. All of these efforts will be important to support the auditor’s opinion.

The new challenges arise when auditors’ discretion is limited due to physical distancing and work from home. By this incident, the organization becomes easier to cover up acts that violate the procedure. If these acts harm other people and make the perpetrator benefited, then it is categorized as fraud

As cited in Integrity-Indonesia.com, health service fraud has become one of the top threats that rise during the pandemic. The fraud includes falsifying a patient’s diagnosis as suspected to corona, or deliberately increasing the number of patients with positive to corona in the hospital in order to get more budget from the government. In June 2020, the government has increased the budget for handling Covid by 17%, to approximately 87.55 billion rupiah, of which 22 billion rupiah are for hospitalization claims. The additional budget may be the incentive to occur health service fraud.

To detect fraud attempts, fraud examiners cannot easily track down all the patients with its diagnosis given by the doctors because there will be so many patients during this pandemic. But together, auditors and fraud examiners can develop a good reporting system that helps to identify suspected fraud. According to Association of Certified Fraud Examiners (ACFE), with that kind of system, it will detect 50% faster than conduct of audits. Thus, the role of the auditor as a key informant who knows hospital compliance makes the auditor a “fraud doctor” of the related health system.

References:

https://www.accountingtools.com/articles/2017/5/14/compliance-test 

https://www.cigna.com/reportfraud/

https://www.integrity-indonesia.com/blog/2020/06/11/the-top-5-threats-that-has-risen-the-most-during-the-covid-19-pandemic/ 

https://www.mutupelayanankesehatan.net/19-headline/3414-waspada-potensi-fraud-dalam-masa-pandemi-covid-19