Oyisultra.com, KENDARI – Polemik dugaan klaim ganda yang menyeret Rumah Sakit (RS) Hermina Kendari akhirnya terjawab. Pihak rumah sakit menegaskan tudingan tersebut tidak benar, dan menyebut kasus ini hanya kesalahpahaman teknis dalam sistem informasi manajemen rumah sakit (SIM-RS).
Humas RS Hermina Kendari, dr. Fauziah, menyatakan pihak rumah sakit tidak pernah melakukan klaim fiktif terhadap biaya perawatan pasien sebagaimana yang dituduhkan.
“Awal masuk, pasien menggunakan BPJS Kesehatan Kelas 3. Namun kemudian pasien meminta untuk mengubah statusnya menjadi pasien umum atau mandiri. Nah, seharusnya sebelum berpindah ke umum, kami menutup alur di SIM-RS dulu. Karena ada kesalahan teknis, sistem masih mencatat penjamin BPJS Kesehatan. Inilah yang kemudian memicu kesalahpahaman,” jelas dr. Fauziah, Senin (25/8/2025).
Senada, Penanggung Jawab Pasien Jaminan Kesehatan Nasional (JKN) RS Hermina Kendari, dr. Indah, juga membantah. Menurutnya, penerbitan Surat Eligibilitas Peserta (SEP) oleh rumah sakit hanyalah prosedur standar bagi pasien yang masuk dengan menggunakan BPJS Kesehatan.
“SEP itu bukan semata-mata untuk klaim. SEP juga berfungsi memastikan kepesertaan pasien aktif, kelas pelayanan, serta apakah ditanggung pemerintah atau mandiri. Setelah pasien memilih beralih ke umum, otomatis biaya menjadi tanggung jawab pasien. Jadi tudingan bahwa kami melakukan klaim pembayaran tidak benar,” tegas dr. Indah.
Pihak RS Hermina Kendari juga menolak isu adanya pemblokiran klaim dari BPJS Kesehatan terhadap rumah sakit mereka.
“Kami sudah memastikan ke BPJS Kesehatan Kendari. Tidak ada pemblokiran, karena memang kami tidak pernah mengajukan klaim untuk pasien tersebut,” tambahnya.
Di sisi lain, Bagian SDM Umum dan Komunikasi Kantor BPJS Kesehatan Cabang Kendari, Sandi, juga menegaskan bahwa pihaknya tidak pernah menerima klaim pembayaran dari RS Hermina Kendari terkait pasien tersebut.
“Kami pastikan tidak ada klaim yang masuk dari RS Hermina untuk pasien itu, dan tidak ada pernyataan dari kami mengenai pemblokiran. Bahkan, sehari setelah aduan masuk, kami langsung mempertemukan kedua belah pihak untuk klarifikasi,” ujar Sandi.
Sandi menuturkan, dalam pertemuan itu pihaknya menjelaskan kepada keluarga pasien bahwa SEP yang diterbitkan hanya berlaku di awal pasien masuk rumah sakit untuk memastikan status kepesertaan BPJS. Namun setelah pasien memutuskan beralih menjadi peserta mandiri, seluruh biaya menjadi tanggung jawab pribadi.
“SEP terbit setelah pasien masuk, bukan setelah keluar. Jadi tidak ada pembayaran klaim yang kami proses. Sejak pasien memilih jalur mandiri, tanggungannya langsung berpindah ke pasien,” tegasnya.
Kasus ini mencuat setelah salah seorang suami pasien mengadukan dugaan adanya klaim ganda yang dilakukan RS Hermina Kendari ke BPJS Kesehatan. Namun, hasil mediasi membuktikan bahwa tidak ada klaim pembayaran yang diajukan rumah sakit, melainkan terjadi miskomunikasi akibat peralihan status pasien dari BPJS ke mandiri.
Diberitakan sebelumnya, seorang pasien Rumah Sakit (RS) Hermina Kendari diduga menjadi korban penyalahgunaan data penjaminan kesehatan oleh pihak rumah sakit
Kasus ini mencuat ke publik setelah Ahmad Ariansyah, suami pasien bernama Yayuk Sapta Bella, mengaku dirugikan karena data istrinya dicatat sebagai peserta BPJS Kesehatan, meskipun ia telah membayar biaya perawatan secara mandiri.
Ahmad menyebut, dugaan manipulasi administrasi tersebut sangat merugikan pihak keluarga. Ia bahkan merasa tertipu setelah mengetahui rumah sakit berusaha melakukan klaim ganda ke BPJS Kesehatan dengan jumlah yang sama seperti pembayaran yang ia keluarkan.
“Saya sudah membayar Rp20.273.000 Juta untuk biaya operasi sesar dan perawatan istri serta anak kembar saya. Tetapi di dalam kwitansi, penjamin justru tercatat BPJS Kesehatan. Setelah saya konfirmasi ke BPJS, ternyata RS Hermina berusaha melakukan klaim dengan jumlah yang sama seperti yang saya bayarkan,” ungkap Ahmad kepada awak media, Sabtu (23/8/2025).
Ahmad menegaskan, dirinya akan menempuh jalur hukum agar kasus ini diusut hingga tuntas. Ia juga berencana bersama sejumlah aktivis dan organisasi masyarakat menggelar aksi unjuk rasa untuk mendesak pertanggungjawaban RS Hermina Kendari dan meminta pengawasan ketat dari BPJS Kesehatan.
“Kami ingin kasus ini dibuka seterang-terangnya. Jangan sampai musibah keluarga saya dijadikan peluang mencari keuntungan dengan cara yang tidak benar,” ujarnya.
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