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Analisis Kesiapan Akreditasi Klinik Melalui Pengembangan Instrumen Audit Internal Berbasis Potensi Fraud: Studi Evaluatif Di Klinik Nuhrintama
Abstract
Pendahuluan: Audit internal klinik berdasarkan KMK No. 1983/2022 kerap terjebak pada paper compliance tanpa mengevaluasi integritas operasional maupun potensi kecurangan. Penelitian ini mengembangkan instrumen audit internal terintegrasi berbasis deteksi risiko kecurangan dan menganalisis kesiapan akreditasi Klinik Nuhrintama secara substantif. Metode: Penelitian deskriptif kualitatif dengan pendekatan readiness assessment dilaksanakan Januari 2026 di Klinik Nuhrintama, Gowa, Sulawesi Selatan. Empat manajer menengah berperan sebagai auditor silang dalam adaptasi Three Lines Model. Matriks Fraud Risk Assessment (FRA) memprioritaskan tiga unit audit dengan triangulasi dan member checking. Instrumen telah divalidasi oleh reviewer program FIHFAA sebelum digunakan. Hasil: FRA mengidentifikasi Loket & RM, Farmasi, dan Billing/Kasir sebagai unit berpotensi risiko sangat tinggi. Audit mengungkap: indikasi pengisian retrospektif rekam medis; potensi selisih stok farmasi 12,4% (proyeksi kerugian tahunan Rp 22,4 juta); empat transaksi void tanpa dokumentasi; dan indikator upcoding pada 18% rekam medis. Skor kepatuhan substantif keseluruhan 44,43% — mengklasifikasikan klinik “Belum Siap” meskipun kelengkapan dokumen administratif melampaui 80%. Kesimpulan: Instrumen berbasis deteksi risiko kecurangan mengonfirmasi fenomena paper compliance dan mengungkap celah yang tidak terdeteksi audit konvensional. Tiga CAPA dirumuskan: digitalisasi kontrol billing (30 hari), penguatan SPO farmasi (60 hari), dan integrasi rekam medis-billing (90 hari).
Kata Kunci: kesiapan akreditasi; audit internal; risiko kecurangan; tata kelola klinik
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DOI: https://doi.org/10.52643/marsi.v10i2.8587
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