|
|
Statistical Results
Corporate and Financial Investigations Department
January 1, 2004 to December 31, 2008
| Corporate and Financial Investigations |
| Professional provider |
2,569 |
321 |
1,075 |
| Group administrators/Brokers |
67 |
23 |
21 |
| Hospital |
319 |
11 |
85 |
| Pharmacist |
76 |
15 |
17 |
| Subscribers |
518 |
203 |
238 |
| Associate |
200 |
191 |
110 |
| Misc. |
999 |
236 |
325 |
| Pharmacy |
1,242 |
10 |
654 |
| Total |
5,990 |
1,010 |
2,525 |
| Referrals for Criminal Prosecution |
| Federal |
142 |
| Philadelphia District Attorney |
27 |
| State of PA |
54 |
| State of NJ |
19 |
| NJ Office of Insurance Fraud-Prosecutors Office |
40 |
| NJ Licensing Bureau |
2 |
| PA Licensing Bureau |
12 |
| Misc. |
28 |
| Regional Advantage Services (RAS) |
1 |
| Total |
325 |
| Indictments/Criminal Information Filed |
85 |
| Sentenced |
65 |
| Financial Results (Fraud, Waste, and Abuse) |
| Restitution |
| Court Ordered |
$8,066,055 |
| Investigations/Support Recoveries |
$3,320,922 |
| Claim Recoveries |
| Professional Claims |
$7,233,326
|
| Facility Claims |
$149,542,819 |
| Claims Denied (Averted Savings) |
$5,264,921 |
| Recovered Savings/Checks Stopped |
$699,316 |
| Recovery Claim Offset |
$2,069,044 |
| Misc. Restitutions |
$1,235,289 |
| Pharmacy Audit Recoveries |
| Durable Medical Equipment |
$1,797,391 |
| Home Infusion Therapy |
$3,451,409 |
| Retail |
$5,793,813 |
| Checks Received |
$1,885,685 |
| Claim Offset |
$2,233,455 |
| Totals |
| Financial Results |
$192,593,445 |
| Group Charge Audits |
$214,293,817 |
|
