TRENTON - Attorney General Matthew J. Platkin announced Friday that Horizon Healthcare Services, Inc., which does business as Horizon Blue Cross Blue Shield of New Jersey, agreed to pay New Jersey $100 million to settle allegations that it fraudulently induced the state to enter into a 2020 contract to administer the state’s employee benefit programs, and then systematically overcharged for healthcare claims throughout the life of that contract. Today’s agreement is the state’s largest-ever non-Medicaid False Claims Act settlement.
The agreement settles allegations that Horizon violated New Jersey’s False Claims Act, which guards against fraud against the government.
While the federal government declined to pursue this matter, the state filed its own Complaint in Intervention in U.S. District Court, alleging three counts of violations of the NJFCA, including fraudulent inducement, presentment of false claims, presentment of false records or statements, as well as claims for breach of contract and unjust enrichment. The complaint has been under seal since it was filed; both the complaint and the settlement were unsealed today.
“At a time when everyone is rightly concerned about the cost of their healthcare, it is simply unacceptable that an insurance company would seek to defraud our State and overcharge us while driving up the costs of healthcare for hundreds of thousands of dedicated public servants,” Platkin said in a release. “We will not hesitate to hold accountable...
If legal proceedings arise between an employee and employer, there may be a strong temptation to present the facts in a more favorable light than they actually are. If an employee makes false clai...