Integrity Fortress Becomes Key to Prevent Fraud in Regional Public Hospitals, Lampung Study Finds
A recent study from University of Lampung and Raden Intan State Islamic University of Lampung reveals that preventing fraud in regional public hospitals requires more than good governance principles alone. The most decisive factor is management’s intention to implement an additional oversight system called the Integrity Fortress. The study was written by Mega Metalia and Agus Kurniawan and published in 2026 in the International Journal of Sustainable Social Science. It highlights how regional public hospitals (RSUD) are particularly vulnerable to fraud because they manage large public budgets, procurement activities, service claims, and complex operational decisions. The findings are significant because RSUDs directly serve the public healthcare system. Weak financial governance in hospitals can affect not only state finances but also the quality of healthcare services available to communities.
A recent study from University of Lampung and Raden Intan State Islamic University of Lampung reveals that preventing fraud in regional public hospitals requires more than good governance principles alone. The most decisive factor is management’s intention to implement an additional oversight system called the Integrity Fortress. The study was written by Mega Metalia and Agus Kurniawan and published in 2026 in the International Journal of Sustainable Social Science. It highlights how regional public hospitals (RSUD) are particularly vulnerable to fraud because they manage large public budgets, procurement activities, service claims, and complex operational decisions. The findings are significant because RSUDs directly serve the public healthcare system. Weak financial governance in hospitals can affect not only state finances but also the quality of healthcare services available to communities.
Why Regional Public Hospitals Are Vulnerable to Fraud
The researchers explain that the healthcare sector is one of the most vulnerable sectors to fraudulent practices. Regional public hospitals, especially those operating under the Regional Public Service Agency (BLUD) model, have greater flexibility in managing income and expenditures. While this flexibility is intended to improve service quality, it can also create opportunities for misuse if internal controls are weak. In Indonesia, the government has promoted Good Hospital Governance (GHG), which emphasizes transparency, accountability, responsibility, independence, and fairness. However, this study shows that GHG alone is not sufficient when it remains only a formal administrative framework.
What Is the “Integrity Fortress”?
In this study, Integrity Fortress refers to a second-layer protection system designed to deter fraud. It includes:
-integrated anti-fraud policies
-whistleblowing systems
-whistleblower protection
-internal investigations
-disciplinary enforcement
-regular fraud risk assessments
In practical terms, the Integrity Fortress creates an environment where potential perpetrators are discouraged from committing fraud because the likelihood of detection and sanctions is perceived as high.
Survey Across 181 Public Hospitals
The study was conducted among management officials of regional public hospitals in Region 1 of Indonesia, covering 181 hospitals and 1,333 management personnel. Respondents included hospital directors, division heads, finance officers, internal auditors, procurement officers, and supervisory board members. Data were collected through questionnaires and analyzed using structural equation modeling. The researchers sought to identify which factors encourage hospital management to adopt the Integrity Fortress and whether it effectively reduces fraud risk.
Main Findings
The study found that fraud deterrence in regional public hospitals is driven more by managerial behavior than by formal regulations alone. Key findings include:
1.Understanding Good Hospital Governance increases management’s intention to implement the Integrity Fortress.
2.Social and moral pressure from supervisors, auditors, and stakeholders also strengthens this intention.
3.Managers’ personal attitudes toward anti-fraud measures do not significantly influence implementation.
4.Perceived control or confidence in implementation does not automatically lead to action.
5.The strongest factor is management’s actual intention to apply the Integrity Fortress, which directly influences fraud deterrence.
This means hospitals whose leadership is genuinely committed to implementing additional anti-fraud mechanisms are more likely to reduce misuse of public funds.
Knowledge Alone Is Not Enough
One of the most notable findings is that understanding good governance principles does not directly reduce fraud. According to the authors, many managers are already familiar with governance concepts, but implementation often remains weak. Common weaknesses include:
-irregular risk assessments
-underdeveloped whistleblowing systems
-internal controls that can be bypassed
-inconsistent disciplinary sanctions
Therefore, governance knowledge must be supported by practical operational systems.
Implications for Public Services
For the public, this research sends a clear message: safeguarding public assets in hospitals is not only about accounting systems but also about building a culture of integrity. If systems such as the Integrity Fortress are widely implemented in regional public hospitals, the potential benefits include:
-more transparent healthcare spending
-more accountable procurement of medicines and medical equipment
-more efficient hospital services
-greater public trust in government healthcare facilities
The authors suggest that this model could be adopted as a policy framework by local governments and health authorities to strengthen oversight in publicly funded healthcare institutions.
Authors’ Perspective
Mega Metalia states that fraud deterrence is not simply the result of formal regulations but a form of organizational behavior that begins with leadership commitment.
Meanwhile, Agus Kurniawan emphasizes that pressure from regulators, auditors, and external stakeholders plays a critical role in encouraging anti-fraud commitment in regional hospitals.
Author Profiles
Mega Metalia is an academic at the Faculty of Economics and Business, University of Lampung. Her expertise includes public sector accounting, organizational governance, and public financial oversight.
Agus Kurniawan is a researcher at Raden Intan State Islamic University of Lampung, specializing in institutional governance, public accountability, and health policy.
Research Source
Metalia, M., & Kurniawan, A. (2026). Protecting Public Assets: Safeguarding RSUD Accountability Through Integrity Fortress. International Journal of Sustainable Social Science, 167–178.
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