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Statistical Results Corporate and Financial Investigations Department
January 1, 2008, to December 31, 2012
Corporate and Financial Investigations |
|||
|---|---|---|---|
Subject type |
Fraud tips received |
Cases initiated |
Tips under investigation |
| Professional provider | 3,062 | 195 | 1,300 |
| Group administrators/Brokers | 48 | 24 | 32 |
| Hospital | 264 | 4 | 94 |
| Pharmacist | 13 | 10 | 7 |
| Subscribers | 466 | 125 | 241 |
| Associate | 111 | 106 | 106 |
| Misc. | 700 | 135 | 289 |
| Pharmacy | 1,095 | 49 | 317 |
| Total | 5,759 | 648 | 2,386 |
Referrals for Criminal Prosecution |
|
|---|---|
| Federal | 121 |
| Philadelphia District Attorney | 17 |
| State of PA | 75 |
| State of NJ | 14 |
| NJ Office of Insurance Fraud-Prosecutors Office | 24 |
| NJ Licensing Bureau | 0 |
| PA Licensing Bureau | 8 |
| Misc. | 5 |
| Regional Advantage Services (RAS) | 0 |
Total |
264 |
| Indictments/Criminal Information Filed | 92 |
| Sentenced | 62 |
Financial Results from Fraud, Waste, and Abuse Recoveries |
|
|---|---|
Restitution |
|
| Court Ordered | $1,673,753 |
Recoveries |
|
| Facility | $241,376,194 |
| Professional | $28,340,303 |
| Investigations/Support | $8,829,357 |
Pharmacy Audit |
|
| Ancillary | $7,802,833 |
| Pharmacy | $23,819,249 |
Totals |
|
| Financial Results | $311,841,689 |
| Group Charge Audits | $168,630,115 |
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