|
|
Anti-Fraud Statistics
January 1, 2003 to December 31, 2007
| Corporate and Financial Investigations |
| Professional provider |
154 |
25 |
62 |
| Group administrators |
5 |
4 |
1 |
| Hospital |
14 |
1 |
8 |
| Pharmacist |
7 |
3 |
3 |
| Subscribers |
48 |
7 |
29 |
| Associate |
14 |
16 |
8 |
| Misc. |
65 |
26 |
30 |
| Total |
307 |
82 |
141 |
| Referrals for Criminal Prosecution |
| NJ Attorney General’s Office |
15 |
| NJ Office of Insurance Fraud — Prosecutor’s Office |
39 |
| NJ Prosecutor’s Office |
7 |
| NJ State Licensing Bureau |
2 |
| Misc. |
2 |
| Total |
65 |
| Indictments/Criminal Information Filed |
3 |
| Sentenced |
3 |
| Financial Results |
| Restitution court ordered |
$208,266 |
Claim recoveries:
- Professional claims
- Facility claims |
$186,821
$2,775,912 |
| Claims denied |
$1,512,489 |
| Checks stopped |
$29,114 |
| Restitution |
$119,996 |
| Recovery claim offset |
$32,570 |
| Pharmacy audit recoveries |
$67,034 |
| Total financial results |
$4,932,202 |
| Losses identified but not yet recovered |
$1,430,727 |
| Group charge audits |
$3,041,273 |
|
