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Statistical Results Corporate and Financial Investigations Department
January 1, 2006, to December 31, 2010
Corporate and Financial Investigations |
|||
|---|---|---|---|
Subject type |
Fraud tips received |
Cases initiated |
Tips under investigation |
| Professional provider | 2,794 | 282 | 1,249 |
| Group administrators/Brokers | 55 | 20 | 30 |
| Hospital | 275 | 3 | 92 |
| Pharmacist | 53 | 8 | 17 |
| Subscribers | 598 | 197 | 311 |
| Associate | 154 | 149 | 150 |
| Misc. | 923 | 204 | 362 |
| Pharmacy | 1,458 | 37 | 756 |
| Total | 6,310 | 900 | 2,967 |
Referrals for Criminal Prosecution |
|
|---|---|
| Federal | 165 |
| Philadelphia District Attorney | 22 |
| State of PA | 69 |
| State of NJ | 23 |
| NJ Office of Insurance Fraud-Prosecutors Office | 25 |
| NJ Licensing Bureau | 0 |
| PA Licensing Bureau | 7 |
| Misc. | 23 |
| Regional Advantage Services (RAS) | 1 |
Total |
335 |
| Indictments/Criminal Information Filed | 97 |
| Sentenced | 59 |
Financial Results from Fraud, Waste, and Abuse Recoveries |
|
|---|---|
Restitution |
|
| Court Ordered | $4,478,925 |
Recoveries |
|
| Facility | $198,814,759 |
| Professional | $22,709,070 |
| Investigations/Support | $8,862,567 |
Pharmacy Audit |
|
| Ancillary | $6,628,727 |
| Pharmacy | $14,698,638 |
Totals |
|
| Financial Results | $256,192,686 |
| Group Charge Audits | $201,027,696 |
