How to detect healthcare fraud? "A systematic review".

OBJECTIVE: To identify the method used in detecting fraud cases. METHODS: Articles searching by using topic-appropriate keywords and incorporated into search engines (data-based) journals Pubmed/Medline, Cochrane, Wiley, ScienceDirect, and secondary data-based Google scholar. Then data extraction is done based on inclusion criteria. The selected articles have the aim of investigating/detecting cases of fraud that have occurred in the health sector or other related sectors that support the study. RESULTS: The findings of the nine reviewed articles have suggested that most of the fraud perpetrators are performed by medical personnel (doctors) and providers. Many types of fraud occur such as insurance claims or medical actions that are completely unadministered nor following the procedure and duplicating claims. The methods that appropriate to be used in detecting fraud are secondary data tracking, information, and technology specialist provision. CONCLUSION: Secondary data tracking is the most widely used method in fraud detection. Fraud perpetrators are ones who dominated by medical circles with fictitious claim cases. Perpetrators tend not to act themselves but in organizations with network.

The evaluation of effect Gammarana intervention to reducing stunting during the Covid-19 pandemic: Protocol evaluation of stunting intervention in Enrekang District.

BACKGROUND: Evaluation of large-scale stunting interventions in Indonesia has never been carried out, because it found limited sensitive and specific interventions that were carried out massively at the village level. The provincial government of South Sulawesi Indonesia in 2020 has implemented a stunting intervention model called Gammarana. The purpose of this evaluation is to analyze the impact of Gammarana on changes in stunting at the project site. Location project as many as 30 villages with a population estimated 60,000.  Design and methods: Evaluation in this study using a retrospective method and internal and external audit to document potential, then validated after the field visit Gammarana first phase in 2020. Basic Logic Model evaluation model with 22 indicators (input, process, secondary output and primary output). Proving the effect of Gammarana on changes in stunting by comparing the phenomena in the comparison village. RESULTS: The comparison villages were set as equal and comparable in 13 indicators that could disturb the study conclusions. The result of the initial condition is that the conditions of the two villages of Gammarana and Villages Comparison are seen as the same in various characteristics, so that whatever the results of this evaluation study are believed to be the impact of Gammarana Project. CONCLUSIONS: this protocol eligible to evaluation of Gammarana Project Intervention in Enrekang District, South Sulawesi Indonesia.

The intervention of maternal nutrition literacy has the potential to prevent childhood stunting: Randomized control trials.

BACKGROUND: Stunting is the impaired growth and development of children due to poor nutrition, repeated infection, and inadequate psychological stimulation. This research aims to examine the impact of maternal nutrition literacy (MNL) in increasing the height or score of a stunted child. DESIGN AND METHODS: This study is a randomized control trial, which uses a sample size of 85 participants, 43 interventions and 42 controls, an 80% stress test and a 95% confidence level. The intervention group of the MNL consists of families with children under the age of five, focused on the mother's ability to perform breastfeeding, hygiene activities, care, and intervention for 3 months. RESULT: The status of stunting was determined by the different distribution of stunting before and after the intervention in both the intervention and control groups. There was a decrease of about 9.3% of MNL in the intervention group, while in the control group it decreased by just 2.4% (p<0.05). CONCLUSIONS: It can be concluded that MNL has an effect in preventing stunting, and it is recommended that preventive measures should focus more on normal children, while stunted children should be provided with breastfeeding as the core of MNL.

The difference in the number of complaints from patient health services using national health insurance at regional general hospitals.

OBJECTIVE: Health services can cause different perceptions of each patient as recipients of health services. This study aims to determine the difference in the number of complaints in several regional general hospitals in Gorontalo Province. METHOD: The method used in this research is interviewing and collecting data in situ at the Gorontalo provincial health office. Data analysis used a one-way analysis of variance. The research sample consisted of seven regional public hospitals in Gorontalo Province. RESULTS: The results showed that the average number of complaints was 15-22 complaints per month in seven hospitals in Gorontalo Province. The average number of health services complaints in several Gorontalo Provincial Hospitals is at the Aloe Saboe Regional General Hospital, 22 complaints per month. CONCLUSIONS: The results showed significant differences in the number of complaints about health services at seven regional general hospitals in Gorontalo Province.

The difference in the number of complaints from patient health services using national health insurance at regional general hospitals

Objective: Health services can cause different perceptions of each patient as recipients of health services. This study aims to determine the difference in the number of complaints in several regional general hospitals in Gorontalo Province. Method: The method used in this research is interviewing and collecting data in situ at the Gorontalo provincial health office. Data analysis used a one-way analysis of variance. The research sample consisted of seven regional public hospitals in Gorontalo Province. Results: The results showed that the average number of complaints was 15–22 complaints per month in seven hospitals in Gorontalo Province. The average number of health services complaints in several Gorontalo Provincial Hospitals is at the Aloe Saboe Regional General Hospital, 22 complaints per month. Conclusions: The results showed significant differences in the number of complaints about health services at seven regional general hospitals in Gorontalo Province. (AU)

How to detect healthcare fraud? “A systematic review”

Objective: To identify the method used in detecting fraud cases. Methods: Articles searching by using topic-appropriate keywords and incorporated into search engines (data-based) journals Pubmed/Medline, Cochrane, Wiley, ScienceDirect, and secondary data-based Google scholar. Then data extraction is done based on inclusion criteria. The selected articles have the aim of investigating/detecting cases of fraud that have occurred in the health sector or other related sectors that support the study. Results: The findings of the nine reviewed articles have suggested that most of the fraud perpetrators are performed by medical personnel (doctors) and providers. Many types of fraud occur such as insurance claims or medical actions that are completely unadministered nor following the procedure and duplicating claims. The methods that appropriate to be used in detecting fraud are secondary data tracking, information, and technology specialist provision. Conclusion: Secondary data tracking is the most widely used method in fraud detection. Fraud perpetrators are ones who dominated by medical circles with fictitious claim cases. Perpetrators tend not to act themselves but in organizations with network. (AU)