Hasil Pencarian  ::  Simpan CSV :: Kembali

"Skripsi ini menganalisis tanggung jawab dokter mengenai tindakan unnecessary medical treatment dan kickback dalam pengajuan klaim pada program asuransi kesehatan Pemerintah di Indonesia dan Amerika Serikat, dengan mengacu pada studi kasus Dokter Farid Fata di Michigan. Kasus Dokter Farid Fata merupakan salah satu kasus health care fraud terbesar di sejarah Amerika Serikat dengan 2 (dua) tindakan fraud utama, yaitu unnecessary medical treatment dan kickback. Tindakan Dokter Farid Fata telah merugikan hampir sebanyak 553 (lima ratus lima puluh tiga) pasien dengan klaim penipuan sebanyak $34 juta kepada Medicare. Skripsi ini disusun dengan metode penelitian doktrinal dengan tipe penelitian preskriptif. Permasalahan hukum dalam skripsi ini mengulas mengenai pengaturan dan pertanggungjawaban hukum terkait tindakan unnecessary medical treatment dan kickback dalam proses pengajuan klaim terhadap program asuransi kesehatan yang dikelola oleh Pemerintah, baik di Indonesia ataupun Amerika Serikat. Selain itu, meneliti mengenai pertanggungjawaban hukum yang dapat dibebankan kepada Dokter Farid Fata apabila hal serupa terjadi di Indonesia, dengan menganalisis regulasi yang berlaku di kedua negara. Kesimpulannya, pertanggungjawaban hukum Dokter Farid Fata secara lebih rinci diatur di Amerika Serikat dibandingkan Indonesia, karena saat ini pengaturan pertanggungjawaban hukum pelaku health care fraud di Indonesia terbatas pada tingkat administratif. Dengan demikian, diberikan saran kepada Pemerintah, BPJS Kesehatan dan mitra BPJS Kesehatan, dokter, serta masyarakat untuk berkolaborasi dan membentuk sistem yang terjamin baik dari segi preventif atau represif guna mengatasi tindakan health care fraud di Indonesia, terkhusus unnecessary medical treatment dan kickback.

---

This thesis analyzes the legal responsibility of doctors regarding unnecessary medical treatment and kickbacks in filing claims in national health insurance programs in Indonesia and the United States, referencing the case study of Doctor Farid Fata in Michigan. The Doctor Farid Fata case is one of the largest health care fraud cases in the history of United States, involving two main types of fraud, unnecessary medical treatment and kickbacks. Doctor Farid Fata’s actions harmed nearly 553 (five hundred and fifty three), resulting in fraudulent Medicare claims amounting $34 million. This thesis is prepared using doctrinal research method with prescriptive research type. The legal issues includes a review of the regulations and legal liabilities related to unnecessary medical treatment and kickbacks in the process of submitting claims to national health insurance programs, both in Indonesia and the United States. Furthermore, it examines the legal liability that can be imposed on Doctor Farid Fata if similar actions occurred in Indonesia, by analyzing the relevant regulations in both countries. In conclusion, the legal liability of Doctor Farid Fata is regulated more comprehensively in the United States compared to Indonesia, as the current legal framework of legal liability towards health care fraud perpetrators in Indonesia is limited to administrative sanctions. Thus, suggestions are given to the Government, BPJS Kesehatan and BPJS Kesehatan partners, doctors, and the public to collaborate and form a guaranteed system both in preventively and repressively, to overcome health care fraud in Indonesia, especially unnecessary medical treatment and kickbacks."

"When John Schilling, an unassuming mid-level accountant, went to work for the Columbia Hospital Corporation, he never expected to become the catalyst for the series of 'whistleblower' cases that ripped through the healthcare industry in the late 1990s. But when he unwittingly discovered that the company was siphoning billions of dollars away from Medicare and stealing from American taxpayers, he was faced with a choice: speak up for what he believed to be right, or remain silent. "Whistleblower" tells the story of Schilling's incredible, harrowing journey from ordinary citizen to federal informant, as he bravely stands up for the truth, treading a dangerous path against corrupt executives, and putting himself in serious personal jeopardy. The book recounts how Schilling, unable to confide in friends or family, allied himself with the FBI and the Justice Department and journeyed into an undercover world in which he learned to wear a wire, and mapped out offices for secret government raids. Suspenseful and provocative, "Whistleblower" chronicles the series of steps that eventually led to the resignation of high-level executives and forced Columbia to return 1.7 billion dollars to the federal government. A compelling account of one man's decision to risk everything for the greater good, this book reveals the personal side of a thankless role that resulted, ultimately, in justice."