|
|
AmeriHealth New Jersey Statistical Results
Corporate and Financial Investigations Department
January 1, 2005 to December 31,2009
| Corporate and Financial Investigations |
| Professional provider |
235 |
15 |
87 |
| Group administrators |
9 |
5 |
4 |
| Hospital |
21 |
1 |
9 |
| Pharmacist |
5 |
0 |
2 |
| Pharmacy Retail |
99 |
1 |
8 |
| Pharmacy-Other (DME, HIT, Mail order, Direct Ship) |
30 |
0 |
17 |
| Subscribers |
69 |
13 |
39 |
| Associate |
14 |
13 |
14 |
| Misc. |
74 |
22 |
31 |
| Total |
556 |
70 |
211 |
| Referrals for Criminal/Civil Prosecution |
| NJ Attorney General’s office |
13 |
| NJ Office of Insurance Fraud — Prosecutors Office |
39 |
| NJ Prosecutor’s Office |
11 |
| NJ Licensing Bureau |
1 |
| Misc. |
1 |
| Total |
65 |
| Indictments/Criminal Informations Arrest |
9 |
| Sentenced |
5 |
| Financial Results from Fraud, Waste, and Abuse Recoveries |
| Restitutions Received |
| Court Ordered |
$200,979 |
| Recoveries |
| Facility |
$3,675,031 |
| Professional |
$534,709
|
| Investigation/Support |
$415,706 |
| Pharmacy Audit |
| Ancillary |
$130,504 |
| Pharmacy |
$163,559 |
| Total |
| Financial Results |
$5,120,488 |
| Charge Audits |
$3,057,561 |
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