| dc.description.abstract | This study examines a case of alleged fictitious claim submissions by a referral
hospital to BPJS Health under a Cooperation Agreement within the National
Health Insurance system. The case emerged following verification findings
indicating inconsistencies between submitted claim documents and actual medical
services provided, resulting in financial losses and temporary contractual
suspension. The research analyzes whether such conduct constitutes a breach of
contract under Indonesian civil law rather than an unlawful act. Employing
normative legal research supported by limited interviews and applying statutory,
conceptual, and case approaches, the study finds that the submission of fictitious
claim documents represents a material breach of contractual obligations under
Articles 1234 and 1243 of the Civil Law, violates the principle of good faith under
Article 1338, and justifies contractual sanctions as agreed by the parties. The
hospital, as a legal entity, bears civil liability grounded in contractual
responsibility. | en_US |
