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|
AmeriHealth New Jersey Statistical Results
Corporate and Financial Investigations Department
January 1, 2004 to December 31, 2008
| Corporate and Financial Investigations |
| Professional provider |
160 |
12 |
56 |
| Group administrators / Brokers |
10 |
6 |
4 |
| Hospital |
16 |
1 |
8 |
| Pharmacist |
4 |
0 |
2 |
| Pharmacy |
116 |
1 |
17 |
| Subscribers |
56 |
12 |
34 |
| Associate |
12 |
13 |
11 |
| Misc. |
63 |
22 |
27 |
| Total |
437 |
67 |
159 |
| Referrals for Criminal/Civil Prosecution |
| NJ Attorney General’s office |
15 |
| NJ Office of Insurance Fraud — Prosecutor’s Office |
40 |
| Prosecutor’s Office |
7 |
| NJ Licensing Bureau |
2 |
| Misc. |
1 |
| Total |
65 |
| Indictments/Criminal Information Filed |
5 |
| Sentenced |
4 |
| Financial Results (Fraud, Waste, and Abuse) |
| Restitution |
| Court Ordered |
$200,579 |
| Investigations/Support Recoveries |
$32,703 |
| Claim Recoveries |
| Professional Claims |
$320,927
|
| Facility Claims |
$3,176,402 |
| Claims Denied (Averted Savings) |
$720,688 |
| Recovered Savings/Checks Stopped |
$33,792 |
| Recovery Claim Offset |
$33,777 |
| Misc. Restitutions |
$45,059 |
| Pharmacy Audit Recoveries |
| Durable Medical Equipment |
$12,971 |
| Home Infusion Therapy |
$58,023 |
| Retail Desk Audit |
$46,480 |
| Totals |
| Financial Results |
$4,681,402 |
| Group Charge Audits |
$2,580,507 |
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