WIJAYA, EMILIA METTA KARUNIA and Simandjuntak, Marcella Elwina and Karlina, Agnesia (2026) Criminalizing JKN Fraud as a White-Collar Crime: Regulatory Reform and Forensic Audit Framework. Criminalizing JKN Fraud as a White-Collar Crime: Regulatory Reform and Forensic Audit Framework, 7 (1). ISSN 2723-2573

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Abstract

National Health Insurance (JKN) fraud causes substantial financial losses, erodes public trust, and threatens the sustainability of Indonesia's healthcare system. This study examines the legal gap between the complexity of JKN fraud and the limitations of the existing criminal law framework using doctrinal legal research with statutory, conceptual, and comparative approaches. Comparative analysis focuses on the National Health Care Anti-Fraud Association (NHCAA) in the United States and the Health Insurance Counter Fraud Group (HICFG) in the United Kingdom. The findings indicate that the current legal framework is inadequate to address the systemic and technology-enabled nature of JKN fraud. Although forensic audits supported by big data analytics enhance fraud detection and investigation, their findings rarely progress beyond administrative enforcement because sector�specific criminal provisions are lacking. This study proposes reforming the SJSN and BPJS Laws by introducing lex specialis provisions on JKN fraud, expanding corporate criminal liability, and strengthening the legal framework for forensic audits. These reforms would improve law enforcement and support the long-term sustainability of the JKN program.

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