LAW ENFORCEMENT ON HEALTHCARE FRAUD: A COMPARATIVE STUDY BETWEEN INDONESIA AND EUROPE

Abstract

Healthcare fraud poses a serious challenge to the financial integrity and ethical foundations of national health systems. This study examines the legal frameworks and enforcement mechanisms used to combat healthcare fraud in Indonesia and selected European countries—namely the Netherlands, the United Kingdom, and Germany. Using a normative and comparative legal research method, the study analyzes statutory provisions, institutional structures, and doctrinal development in each jurisdiction. Findings show that Indonesia's current approach is fragmented, relying on general criminal law and weak administrative regulations, without a clear legal definition of healthcare fraud. Institutional coordination is limited, enforcement data is not transparently reported, and courts have not developed jurisprudence tailored to the healthcare context. In contrast, the European countries studied have established specific legal definitions, dedicated enforcement bodies, and integrated systems that combine criminal, administrative, and civil measures. The study proposes a dual-path enforcement model for Indonesia, recommending legislative reform, procedural integration, specialized institutions, and enhanced judicial interpretation. This article addresses a clear research gap in Indonesian legal scholarship, where healthcare fraud has rarely been analyzed as a distinct legal category within health governance and criminal enforcement literature. By adopting lessons from the European experience, Indonesia can strengthen its legal response to healthcare fraud and protect the sustainability of its national health insurance system.