BPJS Kesehatan; International Social Security Association (2018) Report (multilateral / development partner)

DEFRADA (Deteksi Potensi Fraud Dengan Analista Data Klaim): The development of a fraud detection tool in hospital services

International Social Security Association (ISSA)

Ref: SRC-001-IDN-001

https://ww1.issa.int/gp/173411

Accessed: 3/26/2026

Summary

ISSA Good Practice submission documenting DEFRADA's development by BPJS Kesehatan as a fraud detection tool for INA-CBG claims. Reports 80.6 million claims submissions by end of 2017 and DEFRADA contributing 25-30% of total efficiency gains in 2017. Award category: Information and Communication Technology.

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International Social Security Association (2018). 'DEFRADA (Deteksi Potensi Fraud Dengan Analista Data Klaim): The development of a fraud detection tool in hospital services', ISSA Good Practice gp/173411. Geneva: ISSA. Available at: https://ww1.issa.int/gp/173411 (Accessed 26 Mar 2026).

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Linked Cases (1)

IDN-001 IDN Scaled & Institutionalised

BPJS Kesehatan DEFRADA ML Fraud Detection in Healthcare Claims (Indonesia)

Social insurance Classical ML