Proceedings The 3rd UMY Grace 2022

(Universitas Muhammadiyah Yogyakarta Undergraduate Conference)

ACCOUNTING INFORMATION SYSTEM AND

PREVENTION OF FRAUDULENT DRUG SUPPLY AT THE
KARDINAH TEGAL GENERAL HOSPITAL

Ika Setiyorini1, Desi Susilawati2

12
Accounting study program, Faculty of Vocational Program, Universitas Muhammadiyah Yogyakarta,
Yogyakarta, Indonesia, 55183
Email: ika.setiyorini.vok18@mail.umy.ac.id1, desisusilawati@umy.ac.id2

ABSTRACT environment, if the non-essential sector is an

This study aims to determine the application of unnecessary or non-essential business environment.
accounting information systems, internal control, Industrial sectors included in critical sectors such as
factors causing stock outs, and prevention of fraud in health, disaster management, logistics, transportation,
drug supplies at Kardinah Tegal Hospital. Data distribution for basic needs and others, while those
collection methods used in this study wereobservation, included in essential sectors such as communication
interviews, and documentation. The data used consists and information technology (IT) workers, finance and
of primary data and secondary data. The data analysis banking, capital markets and others, meanwhile if non-
technique used is descriptive qualitative method. The essential sectors such as cafes, restaurants, shopping
results of the study explain that the application of the centers (malls) and others (Rizal et al., 2021). One of
accounting information system for drug supplies as a the government institutions included in the critical
whole is good, including: 1) Kardinah Hospital Tegal sector is a hospital that is engaged in public services
has operated a Pharmacy Hospital Management by offering health services whose products are in the
Information System (SIMRS) as an information form of medical services.
system and efficient management ofmedicines starting In the current era of globalization, technology
from planning, procurement, receipt , distribution, and is progressing very rapidly, all companies or entities
administration of invoice payments, 2) There are SOPs seek to improve and improve quality as much as
related to the logistics management of pharmaceutical possible (Sulisnayanti & Wahyuni, 2017). Likewise in
supplies, out-of-stockhandling procedures that aim to the field of health services, namely hospitals, drug
improve optimal prescription services but in practice supplies must be managed optimally so as to avoid
there are inconsistencies with SOPs so it is shortages (out of stock) or fraud.
recommended for SOP revisions, 3) The current To be able to meet the care needs of patients,
internal control has been appropriate and has the hospital has provided various medical service
implemented internal control standards according to facilities, one of which is pharmacy installation
the Committee of Sponsoring Organization (COSO), services. The pharmacy installation is the most
and 4) The factors causing the scarcity of medicine important part in the hospital to provide and store
supplies include vacancies at distributors, delays in medicines and medical consumables. However, there
delivery of goods, late payments to partners, and na are times when drug supplies run out of stock (stock
available is not sufficient. To prevent fraud, Kardinah out), drug vacancies or out of stock (stock out) or
Tegal Hospital must implement healthy practices to stockpiles (stagnant) have a medical and economic
minimize fraud, both internally and externally. impact, things like this require effective and efficient
drug management efforts. Hali et al., 2021).
Keywords: Accounting Information System, Fraud To facilitate supervision, a system is needed
Prevention, Out of Stock, COSO, Drug Inventory that can monitor any changes in drug supply and can
detect fraud as early as possible. This system must also
INTRODUCTION be able to control the inventory so that inventory
The industrial sector is divided into three management can be disciplined. One of the important
sectors, namely the critical sector, the essential sector, systems needed is an accounting information system
and the non-essential sector. The critical sector is the (AIS) which is aligned according to the needs and
most important business environment, while the conditions. Internal control of merchandise inventory
essential sector is a very necessary or basic business and accounting information systems are very
important in achieving company efficiency and

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effectiveness so that fraud prevention can be carried conditions. Internal control of merchandise inventory
out as early as possible (Mufidah, 2017). and accounting information systems are very
The system used at Kardinah Tegal Hospital is important in achieving company efficiency and
a hospital management information system (SIMRS). effectiveness so that fraud prevention can be carried
Kardinah Tegal Hospital Pharmacy itself is the only out as early as possible (Mufidah, 2017). In the activity
work unit in the distribution of medicines to patients. of managing assets, a company requires an accounting
In managing the drug supply, it is directly connected information system so that existing assets can be
to the main hospital system, namely SIMRS which maintained properly. An accounting information
includes drug orders, prescription services, and stock system is a collection of resources, such as people and
taking. equipment, designed to process data into information.
Inventories of drugs in hospitals are assumed to So that the resulting information can be communicated
be finished goods inventory, where drugs purchased to many decision makers. This system makes it happen
from pharmaceutical companies are then distributed or manually and computerized (Nurhasanah et al., 2019).
sold to patients. Drug supplies with a large enough The system used at Kardinah Tegal Hospital
scale are very easy to cause fraud, for that it needs to is a hospital management information system
be monitored and protected. Fraud can be interpreted (SIMRS). This system is a consolidated information
as an act of fraud that is carried out intentionally by system to handle all management flows starting from
violating several regulations that have been set by the diagnosis and treatment services to patients, medical
parties involved authorized in a company in order to records, pharmacies, pharmacy logistics warehouses,
obtain personal gain and harm other parties SIMRS also handles computerized systems both
(Mardianto & Tiono, 2019). hardware and software and management control in
To be able to face competition, it is necessary the form of network coordination and administrative
to be careful and careful in planning so as to be able to procedures. to obtain accurate and reliable
calculate the ideal purchase number so that there is no information. Kardinah Tegal Hospital Pharmacy
excess or shortage of inventory and does not interfere itself is the only work unit in the distribution of
with the smooth operations of the company and can medicines to patients. In managing the drug supply,
reduce costs (Wijaya et al., 2016). it is directly connected to the main hospital system,
This study aims to explain how the procedures namely SIMRS which includes drug orders,
and accounting information systems for drug supplies, prescription services, and stock taking. The existence
how internal control of drug supplies, what factors of a health information system is quite useful in the
cause a shortage of medicine supplies and how to process of data processing activities, because most of
prevent fraudulent drug supplies at Kardinah Hospital the work is done on computers that have been
Tegal. This study contributes to references for programmed with various programs that are handled
improving SOPs for drug supplies, identification of by an application (Setyawan D, 2016).
factors causing shortages of drug supplies, Inventories of drugs in hospitals are assumed
implementation of internal controls to prevent fraud. to be finished goods inventory, where drugs
purchased from pharmaceutical companies are then
LITERATURE REVIEW distributed or sold to patients. Drug supplies with a
Sulisnayanti & Wahyuni (2017) explain that large enough scale are very easy to cause fraud, for
the system is a series of several interrelated and that it needs to be monitored and protected. Fraud can
interacting components to achieve a goal. Data itself is be interpreted as an act of fraud that is carried out
a fact that is collected, stored, and processed by a intentionally by violating several regulations that
system. Information is data that has been processed have been set by thecompetent parties in a company
and processed to give meaning and to improve the in order to obtain personal gain and harm other
process of making organizational decisions. parties (Mardianto & Tiono, 2019). The continuity of
Accounting is a process of identifying, collecting, and the company can be hampered or may stop if the act
storing data and the process of developing, measuring of fraud or fraud is left unattended without any
and communicating information. precautions and efforts are made to uncover the
To facilitate supervision, a system is needed existence of these actions (Sanusiet al., 2020). Fraud
that can monitor any changes in drug supply and can can also be seen as a form of fraud, concealment of the
detect fraud as early as possible. This system must also truth with the aim of deception or manipulation to the
be able to control inventory so that inventory detriment of the other party. The causes of fraud
management can be disciplined. One of the important according to Donald R Cressey with the fraud triangle
systems needed is an accounting information system theory are pressure, opportunity, and justification.
(AIS) which is aligned according to the needs and Fraud is an illegal act carried out by one person or

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group of people intentionally and planned which to the object of research, interviews with the
causes that person or group to benefit and harmother leadership and employees of pharmacy installations
people or groups (Rika et al., 2020). Acts of fraud and documentation.
itself can be prevented by maximizing internal The data analysis carried out is a comparative
control. In addition, fraud can be prevented on the analysis, namely observing SOPs for procedures and
basis of the awareness of each individual. Handling drug supply systems, comparing SOPs with healthy
carried out to prevent and detect fraud or fraud which practices, internal control of drug supplies by
is often likened to a disease needs to be improved with comparing with COSO, identifying factors for the
various efforts such as providing input, suggestions, occurrence of shortages of medicines supplies, and
proposals or anticipatory actions that need to be preventing fraud medicine supplies.
socialized regularly, so the socialization carried out
must be more adapted to the perpetrators of fraud RESULTS AND DISCUSSION
(fraud) themselves, because in general fraud is Analysis of Drug Inventory Procedures and
carried out by those who have positions or power, Information Systems
have expertise, and are highly educated (Aksa, 2018). Interpreting drug inventory accounting
Eventhough the system has been used, it does not rule information systems and procedures and comparing
out the possibility of running out of stock so it is written SOPs with practice
necessaryto identify the causative factor so that it can (1) Related Functions
be overcome. Out of stock will have an impact on • Head of Pharmacy Installation
servicedelays, while the occurrence of over stock will • Functions of the Pharmacy and Therapeutic
result in swelling of inventory costs. When inventory Committee
exceeds the company's needs, it can result in • Procurement officer
increased maintenance and storage costs while • Reception and Examination Section
increasing the likelihood of goods becoming • Warehouse Section
unusable or damaged. On the other hand, if the • Verification Officer
company tries to minimize inventory, the company • User (Doctor)
will face the problem of scarcity or stock out which (2) Documents used
will hinder the continuity or smooth running of a • Hospital Formulary
company's business activities (Lahu et al., 2017). • Recapitulation List
• Letter of Approval for Request for Goods
METHOD • Mail order
The object of this research is the pharmacy • Work order
installation of Kardinah Tegal Hospital which is • Receipt
located on Jalan AIP KS. Tubun No. 2, Kejambon • Invoice
Village, East Tegal District, Tegal City, Central Java. • Tax Invoice
The type of research used is qualitative descriptive • Minutes of Goods Receipt
research. Types and Sources of Data are Primary Data: • Minutes of Goods Inspection
primary data taken is the result of interviews with • Payment Minutes
related parties regarding the accounting information (3) Accounting records used
system for drug supplies and Secondary Data: • Stock card
secondary data used are general descriptions, job (4) Procedure Network that Forms Drug Inventory
descriptions, drug inventory procedures, internal Management System
policies. • Planning Procedure
Technical data collection is direct observation

Planning Flowchart

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Figure 1. Planning Flowchart Source: Processed Data (2022)

• Procurement Procedure
Procurement Flowchart

Figure 2. Procurement FlowchartSource: Processed Data (2022)

• Admission and Examination ProceduresReceipt and Examination Flowchart

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Figure 3. Receipt and Inspection Flowchart Source: Processed Data (2022)

• Storage Procedure
Storage Flowchart

Figure 4. Storage Flowchart Source: Processed Data (2022)

• Unit Distribution Procedure

Unit Distribution Flowchart

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Figure 5. Unit Distribution Flowchart Source: Processed Data (2022)

• Invoice Payment Administration Procedure
Invoice Payment Administration Flowchart

Figure 6. Invoice Payment Administration Flowchart

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Source: Processed Data (2022)

The following is the data from the review of the

accounting information system for the supply of
medicines at the Kardinah Hospital, Tegal based on the
Standard Operating Procedures (SOP) that apply in
practice:

Table 1. Review of Accounting Information Systems

between SOPs and practices

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and refrigerators, using a perpetual inventory

Source: Processed Data (2022) recording system, using an inventory valuation
system, namely FEFO (First Expired First Out),
Based on table 1 data, it is known that there are stipulates the minimum expiration date for each
four procedures including planning procedures, ordered drug supply, which is at least 2 years,
procurement procedures, receipt procedures, and and organizes stock taking activities every 3
invoice paying administrative procedures that are not months.
in accordance with the applicable SOP. Meanwhile, in • The Pharmacy Installation of Kardinah Tegal
the storage procedure, the distribution procedure is in Hospital has identified and analyzed every form
accordance with the applicable SOP. From the results of risk that may be experienced by looking at the
of research conducted by observing and reviewing potential risks that have been seen and will be
documents, it can be concluded that procedures based seen. Control activities set by the Pharmacy
on practice are more complete than existing SOPs Installation to minimize the risk of expiry of
related to the logistics management process of drug supplies that may occur by setting a
pharmaceutical supplies. However, the application of minimum expiration date for each drug ordered,
the SOP can also be said to be good, it's just that the which is a minimum of approximately 2 years
SOP is too short so it doesn't contain the actual details. for each typeof drug so that the occurrence of
drug expiration can be suppressed, using a
Internal Control Analysis of Drug Inventory perpetual inventory recording system, namely
By using the component analysis of internal every Incoming and outgoing goods will be
inventory control according to the Committee of recorded directly in detailon the stock card, and
Sponsoring Organizations (COSO) (2013) which is also using the inventory valuation system,
the basis for the discussion at Kardinah Tegal namely FEFO (First Expired First Out).
Hospital: (3) Control Activities
(1) Control Environment • The Hospital Pharmacy Installation has studied
• Commitment to integrity and ethical values and understood every risk that may occur in the
embodied in the code of ethics and work culture. hospital by conducting risk identification and
• Supervision of the development and performance analysis so that the risk can be at a level that is
of internal control carried out by the Head of acceptable to the hospital. The Pharmacy
Pharmacy Installation and Deputy Director of Installation has also carried out a division of
Services at Kardinah Tegal Hospital to evaluate authority between functions which is reflected
the adequacy and effectiveness of the internal in the organizational structure. The control
control system. Internal control weaknesses activities built by the pharmaceutical
identified in audit activities are monitored for installationare as follows:
completion and submitted to the Internal • Pharmacy installations use a perpetual
Supervisory Unit and the Director. inventory recording system where every entry
• The organizational structure, authority, and and exit of drugs from the warehouse is always
responsibility are described in the Job recorded in a stock card, besides that the
Description List. recording has beendone computerized.
• Standard Operating Procedures are prepared as • Pharmacy installations use an inventory
guidelines for Operational Work Units in assessment system, namely FEFO (First Expired
Pharmaceutical Installations in carrying out First Out) as an effort to avoid the risk of expiry
pharmaceutical service activities. on drug supplies.
• Commitment to competence embodied in HR • Pharmacy installations set a minimum expiration
management includes planning, recruitment date for each drug ordered at least 2 years as an
and selection, development, incentives, effort to avoid expiry of the drug supply by
enforcement of discipline, performance making a direct request during negotiations with
management. PBF when placing an order.
(2) Risk Assessment • Pharmacy installations carry out physical
• Pharmaceutical installations already have clear inventory counts every three months.
control objectives, namely objectives in the (4) Information and Communication
field of operations related to effectiveness and • The Pharmacy Installation of Kardinah Tegal
efficiency in the implementation of operating Hospital has used relevant information to support
activities by establishing various control internal control. The head of IFRS always
activities such as monitoring room temperature encourages employees to always be aware of

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new regulations that exist both internally and

externally. Internal regulations are regulations
that exist within the Pharmacy Installation, while
external regulations are regulations imposed by
the government regarding drugs and operational
standards.
• The Pharmacy Installation of Kardinah Tegal
Hospital communicates internally to support
internal control. Communication The Head of
IFRS conducts an evaluation to discuss the
deficiencies that occur and coordination with
employees has gone well.
• The Pharmacy Installation at Kardinah Tegal
Hospital communicates well externally to
support internal control. Communicating with
PBF or drug distributors to get the needed items.
(5) Monitoring Activities
• The Pharmacy Installation evaluates the
performance of all employees during ongoing
work or when work has been completed so that
employees know what needs to be improved and
improved.
• Evaluation is carried out by all employees of the
Pharmacy Installation and all parties
communicate properly all the shortcomings they
have so that the best solution can be found.

Following are the results of a review of the

implementation of the internal control system at
Kardinah Hospital Tegal with the Committee of
Sponsoring Organizations (COSO):
Source: Processed Data (2022)
Table 2. Review of Internal Control at
Based on table 2 data, it is known that the
KardinahTegal Hospital with COSO
internal control system in the Pharmacy Installation
of Kardinah Tegal Hospital has implemented an
internalcontrol system as determined by COSO, this
condition is indicated by the fulfillment of all the
principles required by COSO on each control
component.

Analysis of Factors Causing Scarcity of Drug

Supplies
In principle, the inventory of goods in the
warehouse should not exceed or experience a
shortage. Inventory that must remain in accordance
with the standards that have been calculated so that
the inventory does not exceed the standard limits of
goods. The initial process of stock out is when there
is a request for an unserved patient. This can be
caused because the requested item is available but in
quantityit cannot meet the demand or the item is not
availableat all. Kardinah Hospital Tegal if the desired
item is not available, the pharmacy department will
try to negotiate with the user to be able to replace the
drug with the same type but with a different

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trademark. If the negotiation is successful, the patient aims to monitor the safety of pharmaceutical supplies
does not need to buy drugs from outside pharmacies, in all storage and distribution areas so that their safety
but if the negotiations are not successful, the patient can be guaranteed. Fraud prevention can also be
will be advised to buy drugs from outside analyzed from the existence of internal control
pharmacies. elements according to Mulyadi (2016) including:
The factor of running out of stock is not only (1) Organization
seen from the budget and distributors, but also the • Warehouse function authorized to manage
existence of a tiered referral policy which causes the inventory, storage of goods, and distribution to
hospital to experience a decrease in revenue so that it pharmacy service units.
still has outstanding debts in previous years. • Purchasing function carried out by the
Another factor is that the user who plays an active role Procurement Officer of pharmaceutical
in the use of the formulary when prescribing does not supplies in charge of placing an order to a Large
know the condition of the drug supply in the Pharmacy Pharmaceutical Company (PBF).
Warehouse. • The reception function is carried out by the
The internal factor of running out of stock of Receipt and Inspection Team which is in charge
drugs that occurred at Kardinah Hospital Tegal was of receiving ordered pharmaceutical supplies
because the implementation of the use of the formulary andchecking the condition of the ordered goods.
by the user had not run optimally and the lack of • Accounting function performed by the finance
budget due to debts that had not been paid. Meanwhile, department in charge of recording debts arising
the external factor is the occurrence of out of stock due from purchase transactions and making
to large pharmaceutical companies experiencing a payments.
shortage of raw materials for making drugs and delays (2) Authorization
in delivery so that they cannot fulfill the requested • Submission of planning for pharmaceutical
orders and the existence of a tiered referral policy supplies is carried out by a Procurement Officer
which results in a decrease in revenue. After knowing who is authorized by the Head of IFRS and
the causes of stock outs and the obstacles in the Deputy Director of Services.
implementation of each activity, the fulfillment of • Purchase orders to suppliers are authorized by
drug needs as desired, is expected to be realized the Procurement Officer and Head of IFRS.
optimally. • Receipt of pharmaceutical supplies is
Based on the results of observations at the authorizedby the Reception and P2HP.
hospital, it was stated that the occurrence of stock outs • Storage of goods is not authorized by the Head
at Kardinah Tegal Hospital could be caused by several ofIFRS.
things, including: • Distribution of goods is authorized by the Head
(1) Out of stock at distributors. of Pharmacy Warehouse.
(2) Delay in delivery of goods. • Payment of invoices is authorized by the
(3) Late payments to partners. Verification Officer and the Finance
(4) The available funds are insufficient. Department.
(5) The existence of government policies that harm (3) Healthy Practice
thehospital. • Separate purchasing and receiving functions.
In the event of a vacancy in the stock of drugs, • No transaction is carried out by one person or
it has also been regulated in the SOP of Kardinah one organizational unit from beginning to end
Tegal Hospital regarding Cooperation of Pharmacy without the intervention of another person or
Installations with Hospitals or Pharmacies Regarding organizational unit.
the Fulfillment of Empty Drugs for General Patients, • Use of sequentially numbered forms so that
in order to provide medicine for patients at Kardinah their use can be accounted for.
Tegal Hospital when the drug in question is not • Using the full name and signature of the officer
available at the pharmacy installation. with the aim of who filled out the form so that it can be
improving optimal prescription services for patients accounted for its use.
treated at Kardinah Hospital Tegal. With this policy, it • The existence of a network of procedures
is easier to serve patients if there is a stock out. carried out including planning procedures,
procurement procedures, receiving procedures,
Drug Inventory Fraud Prevention Analysis storage procedures, distribution procedures,
Kardinah Tegal Hospital on drug supply refers and invoice payer administration procedures
to the existing SOP on the Protection of which as a whole have been carried out in
Pharmaceutical Supplies from Loss or Theft which accordance with applicable SOPs (standard

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operating procedures). Korupsi pada Sektor Publik dengan Fraud

Internal control in the organizational structure Triangle. Jurnal Ekonomi, Bisnis, Dan
is quite good in terms of the separation of the reception Akuntansi (JEBA), 20(4), 1–17.
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supported, it can be seen that each procedure will be Manajemen Farmasi Rumah Sakit Tk Ii Putri
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Lahu, E. P., Sumarauw, J. S. B., Ekonomi, F.,
CONCLUSIONS AND RECOMMENDATION Manajemen, J., Sam, U., Manado, R., &
The drug inventory accounting information Belakang, L. (2017). Analisis Pengendalian
system run by the Pharmacy Installation of Kardinah Persediaan Bahan Baku Guna Meminimalkan
Tegal Hospital as a whole has been running well, the Biaya Persediaan Pada Dunkin Donuts
Pharmacy Hospital Management Information System Manado. Jurnal EMBA: Jurnal Riset
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Availability of SOPs on Logistics Management of
Pharmaceutical Supplies, Out of Stock Handling Mardianto, M., & Tiono, C. (2019). Analisis
Procedures which aim to improve optimal prescription Pengaruh Fraud Triangle Dalam Mendeteksi
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Business Management and Accounting_Volume 2 Issue 1 (2022)

“Strengthening Youth Potential for Sustainable Innovation” 44