|
|
Anti-Fraud Statistics
January 1, 2001 to December 31, 2007
| Corporate and Financial Investigations |
| Professional provider |
2,658 |
496 |
1,089 |
| Group administrators / Brokers |
81 |
23 |
31 |
| Hospital |
455 |
13 |
133 |
| Pharmacist |
90 |
21 |
32 |
| Subscribers |
626 |
233 |
229 |
| Associate |
225 |
205 |
79 |
| Misc. |
1,066 |
236 |
354 |
| Pharmacy Retail |
526 |
0 |
524 |
| Pharmacy - Other (DME, HIT, Mail order, Direct Ship) |
69 |
0 |
48 |
| Pharmacy Rx Audit |
0 |
1 |
0 |
| Totals |
5,796 |
1,228 |
2,519 |
| Referrals for Criminal Prosecution |
| Federal |
139 |
| Philadelphia District Attorney |
45 |
| State of PA |
54 |
| State of NJ |
18 |
| NJ Office of Insurance Fraud-Prosecutors Office |
62 |
| NJ Licensing Bureau |
2 |
| PA Licensing Bureau |
11 |
| Misc. |
54 |
| Regional Advantage Services (RAS) |
1 |
| Totals |
386 |
| Indictments/Criminal Information Filed |
120 |
| Sentenced |
82 |
| Financial Results (Fraud, Waste, and Abuse) |
| Restitution Court Ordered |
$8,711,122 |
Claim Recoveries:
- Professional Claims
- Facility Claims |
$4,135,989
$139,078,345 |
| Claims Denied |
$11,952,611 |
| Checks Stopped |
$415,212 |
| Restitution |
$3,014,340 |
| Pharmacy Audit Recoveries |
$11,597,133 |
| Recovered Claims Offset |
$2,124,632 |
| Miscellaneous Restitution |
$1,657,050 |
| Total Financial Results |
$182,686,434 |
| Losses Identified But Not Yet Recovered |
$67,484,066 |
| Group Charge Audits |
$192,300,694 |
|
