Implementation of Indonesian Positive Law in Combating Fraud and Forgery in Health Insurance and Protection against Industrial Losses
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Abstract
Fraud and forgery in health insurance pose a serious threat to the stability of the industry, the sustainability of financing schemes, and trust between insurers and insured parties. Various forms of fraud arise in the registration process, medical services, and claims submitted by participants, health workers, and agents. In Indonesian positive law, protection of insurance integrity is supported by civil, commercial, and criminal provisions, including the obligation to disclose material facts, the principle of absolute honesty, and criminal penalties for fraud and document forgery. This study examines how these norms work to suppress fraudulent practices and assesses the capacity of the law to provide guarantees for the health insurance industry. The results of the study show that the Indonesian legal system has provided a strong substantive framework, but its effectiveness is largely determined by administrative oversight mechanisms, the quality of medical verification, and the ability to provide evidence. Legal instruments serve to prevent, correct, and prosecute perpetrators of fraud, while minimizing potential financial losses for insurers. This study concludes that the integration of legal norms and operational control systems is necessary for optimal fraud eradication efforts.
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