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