Hospital criminal liability for JKN claim fraud: reconstructing corporate fault across indonesia’s criminal, corruption and health laws
DOI:
https://doi.org/10.59651/relae.v18i02.489Keywords:
Corporate Criminal Liability, Corporate Fault, Deferred Prosecution Agreements, JKN Claim Fraud, New Indonesian Criminal CodeAbstract
Fraudulent claims under Indonesia's National Health Insurance (Jaminan Kesehatan Nasional, JKN) program have predominantly been addressed through administrative sanctions, despite hospitals submitting claims and receiving payments. Indonesia's new Criminal Code (Law No. 1 of 2023), effective January 2, 2026, and adjusted by Law No. 1 of 2026, recognizes corporations as subjects of criminal offenses. However, the attribution of corporate fault to hospitals remains legally complex. This normative juridical study employs statutory and conceptual approaches to examine hospital criminal liability under the Criminal Code, the Corruption Eradication Law, and the Health Law, and to determine how unlawful corporate benefit and fault can be established in fraudulent JKN claims. The study proposes a Three-Layer Corporate Fault Test encompassing attribution of conduct to individuals acting within or controlling the hospital, unlawful corporate benefit, and failure to prevent or tolerance of criminal conduct. The third layer is assessed using anti-fraud obligations under Minister of Health Regulation No. 16 of 2019. The analysis demonstrates that the Health Law does not specifically criminalize JKN claim fraud or expressly recognize failure to prevent as a basis of corporate fault. Furthermore, the legal separation of JKN fund assets from BPJS assets complicates the establishment of losses to state finances. The new Criminal Procedure Code also introduces deferred prosecution agreements exclusively for corporations, subject to judicial oversight. The proposed test provides a structured evidentiary framework for prosecutors and judges to distinguish individual misconduct from institutional fault and establish hospital criminal liability.
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