Corporate and Financial Investigations |
|||
|---|---|---|---|
Subject type |
Fraud tips received |
Cases initiated |
Tips under investigation |
| Professional provider | 3,415 | 247 | 1,259 |
| Group administrators/Brokers | 60 | 24 | 33 |
| Hospital | 313 | 4 | 92 |
| Pharmacist | 57 | 12 | 14 |
| Subscribers | 667 | 165 | 287 |
| Associate | 169 | 120 | 121 |
| Misc. | 1050 | 182 | 348 |
| Pharmacy | 1,565 | 41 | 652 |
| Total | 7,296 | 795 | 2,806 |
Referrals for Criminal Prosecution |
|
|---|---|
| Federal | 154 |
| Philadelphia District Attorney | 19 |
| State of PA | 70 |
| State of NJ | 22 |
| NJ Office of Insurance Fraud-Prosecutors Office | 21 |
| NJ Licensing Bureau | 0 |
| PA Licensing Bureau | 8 |
| Misc. | 15 |
| Regional Advantage Services (RAS) | 1 |
Total |
310 |
| Indictments/Criminal Information Filed | 103 |
| Sentenced | 63 |
Financial Results from Fraud, Waste, and Abuse Recoveries |
|
|---|---|
Restitution |
|
| Court Ordered | $1,284,094 |
Recoveries |
|
| Facility | $220,282,505 |
| Professional | $26,394,313 |
| Investigations/Support | $9,042,117 |
Pharmacy Audit |
|
| Ancillary | $6,837,439 |
| Pharmacy | $15,726,285 |
Totals |
|
| Financial Results | $279,566,753 |
| Group Charge Audits | $194,528,493 |