Faktor-Faktor yang Berpengaruh Terhadap Pencegahan Kecurangan di RSUD Kelas B Kabupaten Sukabumi
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Published
Nov 23, 2025
Abstract
Fraud or fraudulent behavior at Sukabumi Regional General Hospital is reflected in claims for two or more diagnoses that should be included in a single service package in the same episode to obtain a larger claim value in a single patient care episode. The purpose of this study is to provide solutions to efforts to improve fraud prevention by improving factors such as the effectiveness of internal control, clinical pathway compliance, and building good clinical governance. The study used a quantitative design that analyzes the causal influence along with descriptive analysis using the three-box method. Respondents consisted of 180 hospital staff consisting of nurses and doctors. The sampling method used was purposive sampling. The data analysis method used was the PLS-SEM. The results of the study indicate that the effectiveness of internal control, clinical pathway compliance, and clinical governance simultaneously influence fraud prevention. The effectiveness of internal control, clinical pathway compliance, and clinical governance each have a positive effect on fraud prevention. The effectiveness of internal control and clinical pathway compliance each have a positive effect on clinical governance. A comprehensive evaluation of budget management is needed, especially in areas that have the potential for waste. Efficiency efforts need to be supported by thorough budget planning, the use of financial information systems, and increased accountability of each work unit in the use of operational funds.
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How to Cite
Kurniawan, R., Eff, A. R. Y. and Rini, T. (2025) “Faktor-Faktor yang Berpengaruh Terhadap Pencegahan Kecurangan di RSUD Kelas B Kabupaten Sukabumi”, Ranah Research : Journal of Multidisciplinary Research and Development, 8(1), pp. 757-771. doi: 10.38035/rrj.v8i1.1932.
References
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Andreisová, L. (2016). Building and maintaining an effective compliance program. International Journal of Organizational Leadership, 5(1), 24–39.
Ardiana, T. E. (2020). The Influence Of Financial Reporting Compliance, Government Personnel Competency Towards Fraud Prevention In Village Fund Management"(Case Study In Kecamatan Siman Kabupaten Ponorogo). International Journal of Economics, Business and Accounting Research (IJEBAR), 4(4).
Bussmann, K. D., & Niemeczek, A. (2019). Compliance through company culture and values: An international study based on the example of corruption prevention. Journal of Business Ethics, 157(3), 797–811.
Chin, W. W. (1998). Commentary: Issues and opinion on structural equation modeling. In MIS quarterly (pp. vii–xvi). JSTOR.
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COSO. (2013b). Internal Control – Integrated Framework. https://assets.kpmg.com/content/dam/kpmg/pdf/2016/05/2750-New-COSO-2013-Framework-WHITEPAPER-V4.pdf
De Bleser, L., Depreitere, R., Waele, K. D. E., Vanhaecht, K., Vlayen, J., & Sermeus, W. (2006). Defining pathways. Journal of Nursing Management, 14(7), 553–563.
Din, M., Laupe, S., & Iqbal, M. (2021). The Effect of Local Apparatus Competence, Financial Reporting Compliance and Internal Control Environment on Fraud Prevention: The Role of Local Assistants as Moderation Variable. International Conference on Strategic Issues of Economics, Business and, Education (ICoSIEBE 2020), 57–60.
Ellis, B. W., & Johnson, S. (1999). The care pathway: a tool to enhance clinical governance. British Journal of Clinical Governance, 4(2), 61–72.
Farochi, M. F. F., & Nugroho, A. H. D. (2022). Pengaruh pengendalian internal dan good corporate governance terhadap pencegahan fraud. Jurnal Penelitian Dan Pengembangan Sains Dan Humaniora, 6(1), 86–92.
Fatimah, R. N., Misnaniarti, M., & Syakurah, R. A. (2021). Potential Fraud in The Implementation of National Health Insurance in The Health Sector: Systematic Review. JMMR (Jurnal Medicoeticolegal Dan Manajemen Rumah Sakit), 10(3), 255–270.
Gottwald, M., & Lansdown, G. (2021). Clinical governance: improving the quality of healthcare for patients and service users. McGraw-Hill Education (UK).
Hair, J. F., Babin, B. J., Black, W. C., & Anderson, R. E. (2019). Multivariate Data Analysis. Cengage. https://books.google.co.id/books?id=0R9ZswEACAAJ
Halton, K., Hall, L., Gardner, A., MacBeth, D., & Mitchell, B. G. (2017). Exploring the context for effective clinical governance in infection control. American Journal of Infection Control, 45(3), 278–283.
Hanifah, A. M., Kuntadi, C., & Pramukty, R. (2023). Literature review: Pengaruh sistem pengendalian internal, peran audit internal, komitmen manajemen terhadap good corporate governance. Jurnal Economina, 2(6), 1318–1330.
Haruddin, H., Purwana, D., & Anwar, C. (2021). Phenomenon of causal fraud health insurance in hospitals: theory of gear fraud. Asia Pacific Journal of Health Management, 16(4), 177–185.
Heriyanto, Y., & Sari, N. (2021). Pengaruh Good Governance, Reformasi Administrasi Perpajakan Dan Sanksi Administrasi Pajak Terhadap Kepatuhan Wajib Pajak Restoran Pada Wilayah Administrasi Kecamatan Cempaka Putih Jakarta Pusat. Jurnal Pajak Vokasi (JUPASI), 3(1), 1–10.
John, K., Makhija, A. K., & Feris, S. P. (2013). Advances in Financial Economics. Emerald Group Publishing Limited.
Koerniawan, K. A. (2017). Fraud Prevention: A Study In Regional Public Service Agency (BLUD) For Hospital In Malang Regency, Indonesia. International Journal Of Scientific & Technology Research, 6(4), 1–14.
Kurniawan, P. C., & Izzaty, K. N. (2019). Pengaruh Good Corporate Governance dan Pengendalian Internal Terhadap Pencegahan Fraud. ECONBANK: Journal of Economics and Banking, 1(1), 55–60.
Maharani, R., BZ, F. S., & Priantana, R. D. (2023). Implementasi Sistem Pengendalian Internal dalam Upaya Mewujudkan Good Governance pada Lembaga Layanan Pendidikan Tinggi. Jurnal Samudra Ekonomi Dan Bisnis, 14(3), 555–566.
Maliapen, M., & Dangerfield, B. C. (2010). A system dynamics-based simulation study for managing clinical governance and pathways in a hospital. Journal of the Operational Research Society, 61(2), 255–264.
Mitriza, A., & Akbar, A. (2019). Analisis Pengendalian Potensi Fraud di Rumah Sakit Umum Daerah Achmad Moechtar Bukittinggi. Jurnal Kesehatan Andalas, 8(3), 493–499.
Ni’am, S., & Ramadhan, A. (2024). Skandal Klaim Fiktif ke BPJS, Pemilik RS hingga Keluarganya Diduga Terlibat. https://nasional.kompas.com/read/2024/07/25/09372081/skandal-klaim-fiktif-ke-bpjs-pemilik-rs-hingga-keluarganya-diduga-terlibat
Nugroho, D. H., & Afifi, Z. (2022). Pengaruh pengendalian internal dan good corporate governance terhadap pencegahan fraud. Yudishtira Journal: Indonesian Journal of Finance and Strategy Inside, 2(3), 301–316.
Pan, K., Pearce, C., Jones, S. T., & Lui, Z. (2023). Types of Hospital Frauds: Nature and Methods of Prevention. Journal of Forensic and Investigative Accounting, 15(1).
Pratama, I. R. (2024). KPK Ungkap Fraud Klaim JKN hingga Rp 35 Miliar. https://www.tribunnews.com/nasional/2024/07/25/kpk-ungkap-fraud-klaim-jkn-hingga-rp-35-miliar
Rahmawati, Y., Kuntadi, C., & Pramukty, R. (2023). Literature Review: Pengaruh Integritas, Profesionalisme Auditor Internal Dan Good Corporate Governance Terhadap Pencegahan Kecurangan. Jurnal Economina, 2(6), 1475–1486.
Ramayani, N., Rosyidah, R., & Hidayat, M. S. (2024). Implementasi Clinical Pathway Terhadap Mutu, Biaya dan Varians Pelayanan: Suatu Studi Literatur. Jurnal Formil (Forum Ilmiah) Kesmas Respati, 9(1), 32–40.
Riandini, R. R., Arifiyanto, A. Y., Rochmah, T. N., Chalidyanto, D., & Purwaningtyas, R. M. (2023). Compliance with Clinical Pathways and Pilot Implementation Impact on Financial Outcome in Hospitals Using National Health Insurance: An Action Research. JMMR (Jurnal Medicoeticolegal Dan Manajemen Rumah Sakit), 12(3), 351–365.
Sanusi, S. F., Sutrisno, S., & Suwiryo, D. H. (2020). Pengaruh Corporate Governance dan Kualitas Audit terhadap Pencegahan Kecurangan. Kompartemen: Jurnal Ilmiah Akuntansi, 17(1).
Sari, A. N., & Priantana, R. D. (2023). Pengaruh Audit Operasional, Pengendalian Internal, dan Good Clinical Governance terhadap Efektivitas Pelayanan Kesehatan pada Rumah Sakit Tipe B di Banda Aceh. Jurnal Penelitian Ekonomi Akuntansi (JENSI), 7(1), 34–48.
Sawmar, A. A., & Mohammed, M. O. (2021). Enhancing zakat compliance through good governance: a conceptual framework. ISRA International Journal of Islamic Finance, 13(1), 136–154.
Scally, G., & Donaldson, L. J. (1998). Clinical governance and the drive for quality improvement in the new NHS in England. Bmj, 317(7150), 61–65.
Shanker, G. (2025). Artificial Intelligence in Policy Formulation: Designing Transparent Systems for Regulatory Compliance and Financial Fraud Prevention.
Soleman, R. (2013). Pengaruh pengendalian internal dan good corporate governance terhadap pen cegahan fraud. Jurnal Akuntansi Dan Auditing Indonesia, 17(1), 57–74.
Sugiarti, I., Masturoh, I., & Fadly, F. (2023). Efforts to prevent fraud in implementation of JKN (national health insurance). AIP Conference Proceedings, 2510(1).
Suyono, E., & Hariyanto, E. (2012). Relationship between internal control, internal audit, and organization commitment with good governance: Indonesian case. China-USA Business Review, 11(9).
Al-Zwyalif, I. M. (2015). The role of internal control in enhancing corporate governance: Evidence from Jordan. International Journal of Business and Management, 10(7), 57.
Amsaroka, M. H., Yadiati, W., & Winarningsih, S. (2024). Literature review: the relationship between internal control system of the government (spip), good government governance (ggg), and fraud prevention. JASa (Jurnal Akuntansi, Audit Dan Sistem Informasi Akuntansi), 8(1), 122–136.
Andreisová, L. (2016). Building and maintaining an effective compliance program. International Journal of Organizational Leadership, 5(1), 24–39.
Ardiana, T. E. (2020). The Influence Of Financial Reporting Compliance, Government Personnel Competency Towards Fraud Prevention In Village Fund Management"(Case Study In Kecamatan Siman Kabupaten Ponorogo). International Journal of Economics, Business and Accounting Research (IJEBAR), 4(4).
Bussmann, K. D., & Niemeczek, A. (2019). Compliance through company culture and values: An international study based on the example of corruption prevention. Journal of Business Ethics, 157(3), 797–811.
Chin, W. W. (1998). Commentary: Issues and opinion on structural equation modeling. In MIS quarterly (pp. vii–xvi). JSTOR.
COSO. (2013a). COSO Internal Framework - Integrated Framework. The Committee of Sponsoring Organizations of the Treadway Commission.
COSO. (2013b). Internal Control – Integrated Framework. https://assets.kpmg.com/content/dam/kpmg/pdf/2016/05/2750-New-COSO-2013-Framework-WHITEPAPER-V4.pdf
De Bleser, L., Depreitere, R., Waele, K. D. E., Vanhaecht, K., Vlayen, J., & Sermeus, W. (2006). Defining pathways. Journal of Nursing Management, 14(7), 553–563.
Din, M., Laupe, S., & Iqbal, M. (2021). The Effect of Local Apparatus Competence, Financial Reporting Compliance and Internal Control Environment on Fraud Prevention: The Role of Local Assistants as Moderation Variable. International Conference on Strategic Issues of Economics, Business and, Education (ICoSIEBE 2020), 57–60.
Ellis, B. W., & Johnson, S. (1999). The care pathway: a tool to enhance clinical governance. British Journal of Clinical Governance, 4(2), 61–72.
Farochi, M. F. F., & Nugroho, A. H. D. (2022). Pengaruh pengendalian internal dan good corporate governance terhadap pencegahan fraud. Jurnal Penelitian Dan Pengembangan Sains Dan Humaniora, 6(1), 86–92.
Fatimah, R. N., Misnaniarti, M., & Syakurah, R. A. (2021). Potential Fraud in The Implementation of National Health Insurance in The Health Sector: Systematic Review. JMMR (Jurnal Medicoeticolegal Dan Manajemen Rumah Sakit), 10(3), 255–270.
Gottwald, M., & Lansdown, G. (2021). Clinical governance: improving the quality of healthcare for patients and service users. McGraw-Hill Education (UK).
Hair, J. F., Babin, B. J., Black, W. C., & Anderson, R. E. (2019). Multivariate Data Analysis. Cengage. https://books.google.co.id/books?id=0R9ZswEACAAJ
Halton, K., Hall, L., Gardner, A., MacBeth, D., & Mitchell, B. G. (2017). Exploring the context for effective clinical governance in infection control. American Journal of Infection Control, 45(3), 278–283.
Hanifah, A. M., Kuntadi, C., & Pramukty, R. (2023). Literature review: Pengaruh sistem pengendalian internal, peran audit internal, komitmen manajemen terhadap good corporate governance. Jurnal Economina, 2(6), 1318–1330.
Haruddin, H., Purwana, D., & Anwar, C. (2021). Phenomenon of causal fraud health insurance in hospitals: theory of gear fraud. Asia Pacific Journal of Health Management, 16(4), 177–185.
Heriyanto, Y., & Sari, N. (2021). Pengaruh Good Governance, Reformasi Administrasi Perpajakan Dan Sanksi Administrasi Pajak Terhadap Kepatuhan Wajib Pajak Restoran Pada Wilayah Administrasi Kecamatan Cempaka Putih Jakarta Pusat. Jurnal Pajak Vokasi (JUPASI), 3(1), 1–10.
John, K., Makhija, A. K., & Feris, S. P. (2013). Advances in Financial Economics. Emerald Group Publishing Limited.
Koerniawan, K. A. (2017). Fraud Prevention: A Study In Regional Public Service Agency (BLUD) For Hospital In Malang Regency, Indonesia. International Journal Of Scientific & Technology Research, 6(4), 1–14.
Kurniawan, P. C., & Izzaty, K. N. (2019). Pengaruh Good Corporate Governance dan Pengendalian Internal Terhadap Pencegahan Fraud. ECONBANK: Journal of Economics and Banking, 1(1), 55–60.
Maharani, R., BZ, F. S., & Priantana, R. D. (2023). Implementasi Sistem Pengendalian Internal dalam Upaya Mewujudkan Good Governance pada Lembaga Layanan Pendidikan Tinggi. Jurnal Samudra Ekonomi Dan Bisnis, 14(3), 555–566.
Maliapen, M., & Dangerfield, B. C. (2010). A system dynamics-based simulation study for managing clinical governance and pathways in a hospital. Journal of the Operational Research Society, 61(2), 255–264.
Mitriza, A., & Akbar, A. (2019). Analisis Pengendalian Potensi Fraud di Rumah Sakit Umum Daerah Achmad Moechtar Bukittinggi. Jurnal Kesehatan Andalas, 8(3), 493–499.
Ni’am, S., & Ramadhan, A. (2024). Skandal Klaim Fiktif ke BPJS, Pemilik RS hingga Keluarganya Diduga Terlibat. https://nasional.kompas.com/read/2024/07/25/09372081/skandal-klaim-fiktif-ke-bpjs-pemilik-rs-hingga-keluarganya-diduga-terlibat
Nugroho, D. H., & Afifi, Z. (2022). Pengaruh pengendalian internal dan good corporate governance terhadap pencegahan fraud. Yudishtira Journal: Indonesian Journal of Finance and Strategy Inside, 2(3), 301–316.
Pan, K., Pearce, C., Jones, S. T., & Lui, Z. (2023). Types of Hospital Frauds: Nature and Methods of Prevention. Journal of Forensic and Investigative Accounting, 15(1).
Pratama, I. R. (2024). KPK Ungkap Fraud Klaim JKN hingga Rp 35 Miliar. https://www.tribunnews.com/nasional/2024/07/25/kpk-ungkap-fraud-klaim-jkn-hingga-rp-35-miliar
Rahmawati, Y., Kuntadi, C., & Pramukty, R. (2023). Literature Review: Pengaruh Integritas, Profesionalisme Auditor Internal Dan Good Corporate Governance Terhadap Pencegahan Kecurangan. Jurnal Economina, 2(6), 1475–1486.
Ramayani, N., Rosyidah, R., & Hidayat, M. S. (2024). Implementasi Clinical Pathway Terhadap Mutu, Biaya dan Varians Pelayanan: Suatu Studi Literatur. Jurnal Formil (Forum Ilmiah) Kesmas Respati, 9(1), 32–40.
Riandini, R. R., Arifiyanto, A. Y., Rochmah, T. N., Chalidyanto, D., & Purwaningtyas, R. M. (2023). Compliance with Clinical Pathways and Pilot Implementation Impact on Financial Outcome in Hospitals Using National Health Insurance: An Action Research. JMMR (Jurnal Medicoeticolegal Dan Manajemen Rumah Sakit), 12(3), 351–365.
Sanusi, S. F., Sutrisno, S., & Suwiryo, D. H. (2020). Pengaruh Corporate Governance dan Kualitas Audit terhadap Pencegahan Kecurangan. Kompartemen: Jurnal Ilmiah Akuntansi, 17(1).
Sari, A. N., & Priantana, R. D. (2023). Pengaruh Audit Operasional, Pengendalian Internal, dan Good Clinical Governance terhadap Efektivitas Pelayanan Kesehatan pada Rumah Sakit Tipe B di Banda Aceh. Jurnal Penelitian Ekonomi Akuntansi (JENSI), 7(1), 34–48.
Sawmar, A. A., & Mohammed, M. O. (2021). Enhancing zakat compliance through good governance: a conceptual framework. ISRA International Journal of Islamic Finance, 13(1), 136–154.
Scally, G., & Donaldson, L. J. (1998). Clinical governance and the drive for quality improvement in the new NHS in England. Bmj, 317(7150), 61–65.
Shanker, G. (2025). Artificial Intelligence in Policy Formulation: Designing Transparent Systems for Regulatory Compliance and Financial Fraud Prevention.
Soleman, R. (2013). Pengaruh pengendalian internal dan good corporate governance terhadap pen cegahan fraud. Jurnal Akuntansi Dan Auditing Indonesia, 17(1), 57–74.
Sugiarti, I., Masturoh, I., & Fadly, F. (2023). Efforts to prevent fraud in implementation of JKN (national health insurance). AIP Conference Proceedings, 2510(1).
Suyono, E., & Hariyanto, E. (2012). Relationship between internal control, internal audit, and organization commitment with good governance: Indonesian case. China-USA Business Review, 11(9).