Fraud dalam Program Jaminan Kesehatan Nasional (JKN) merupakan tantangan serius yang berdampak pada keberlangsungan program dan mutu pelayanan kesehatan. RSUD H. Abdurrahman Sayoeti sebagai salah satu rumah sakit rujukan di Kota Jambi dinilai berhasil mengelola pelayanan JKN tanpa indikasi praktik fraud. Penelitian ini bertujuan untuk menganalisis strategi pencegahan fraud dalam program JKN di RSUD H. Abdurrahman Sayoeti untuk menjamin mutu layanan kesehatan. Penelitian ini merupakan studi kualitatif dengan desain deskriptif, dilakukan pada April-Mei 2025. Informan penelitian terdiri dari direktur rumah sakit, Direktur Pelayanan, serta anggota tim kendali mutu dan biaya, yang dipilih melalui teknik purposive sampling. Data dikumpulkan melalui wawancara mendalam dan telaah dokumen, serta dianalisis menggunakan metode analisis tematik. Hasil penelitian menunjukkan bahwa strategi pencegahan fraud di RSUD H. Abdurrahman Sayoeti dilakukan melalui penerapan kebijakan anti-fraud yang mengacu pada Permenkes No. 16 Tahun 2019, pembentukan tim kendali biaya dan mutu, serta sosialisasi dan pelatihan kepada tenaga kesehatan. Rumah sakit juga menerapkan audit internal secara berkala dan mendorong budaya kerja yang transparan dan akuntabel. Tantangan yang dihadapi mencakup keterbatasan SDM terlatih dan keterpaduan antar unit kerja. Kesimpulannya, strategi pencegahan fraud yang dilaksanakan mampu memperkuat sistem layanan yang efisien dan bermutu. Disarankan agar rumah sakit meningkatkan pelatihan anti-fraud secara berkala dan memperluas koordinasi lintas unit untuk efektivitas pengawasan dan keberlanjutan program JKN.

Fraud in the National Health Insurance Programme (JKN) is a serious challenge that affects the sustainability of the programme and the quality of health services. RSUD H. Abdurrahman Sayoeti as one of the referral hospitals in Jambi City is considered successful in managing JKN services without indications of fraud practices. This study aims to analyse fraud prevention strategies in the JKN program at RSUD H. Abdurrahman Sayoeti to ensure the quality of health services. This research is a qualitative study with a descriptive design, conducted in April-May 2025. Research informants consisted of the hospital director, Director of Services, and members of the quality and cost control team, who were selected through purposive sampling techniques. Data were collected through in-depth interviews and document review, and analysed using thematic analysis method. The results showed that fraud prevention strategies at RSUD H. Abdurrahman Sayoeti were carried out through the implementation of anti-fraud policies that refer to Permenkes No. 16 of 2019, the formation of cost and quality control teams, as well as socialisation and training for health workers. The hospital also implements regular internal audits and encourages a transparent and accountable work culture. Challenges faced include limited trained human resources and integration between work units. In conclusion, the fraud prevention strategies implemented were able to strengthen an efficient and quality service system. It is recommended that hospitals increase anti-fraud training on a regular basis and expand cross-unit coordination for effective oversight and sustainability of the JKN programme.