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Fraud can be happened at all of governmental sector include at health sector. This research aim to test the effect determinant of fraud, internal control system role/Sistem Pengendalian Internal (SPI) and its implication to accountability of finance at first level of health facility ( FKTP) / puskesmas. The test is to be done at 132 respondens that show 48 % of population. This research use the structural model analysis that is PLS ( Partial Least Square). The result of this research shows the asymmetric information (AI) have positive and significant effect to fraud, while compliance of accounting rule/ketaatan aturan akuntansi (KAA) and organizational commitment (KO) have negativ and no significant effect. The internal control system earn to moderation the relation compliance of rule to fraud (pure moderation), while at asymetric information and organizational commitment only have potency to moderation of relation (homologizer moderation). Therefore, fraud have negative and significant effect to acountability of finance/akuntabilitas keuangan (AK). The implication this research is efectifiy of internal control system applying specially internal control system applying on duty health so that can become the appliance to anticipate and detect early ( built in control) to inconsistence or interpose the collision which possible arise in FKTP / puskesmas. There by to be Internal Control system applying become effective, need the existence of regulation and supporter policy representing generation of Government Rule No. 60/2008 about Governmental Internal Control System/SPI to make easy down the application of Internal Control System applying.