NEW YORK (BLOOMBERG) -- Horizon Blue Cross Blue Shield of New Jersey agreed to pay $100 million to resolve allegations that the health-insurance company had ripped off taxpayers by overpaying for care, in a pact made public on Friday.
The settlement with New Jersey Attorney General Matthew Platkin brings to an end a lawsuit against Horizon initiated by several whistleblowers. Rising expenses in the state employee health plan had been pushing up costs for taxpayers for years.
The state entrusted Horizon to provide benefits for hundreds of thousands of workers. But a yearslong investigation “revealed that Horizon betrayed that trust and took advantage of the state,” Platkin said at a news conference in Newark on Friday.
Platkin called the Horizon pact the single largest False Claims Act settlement in New Jersey state history, outside of Medicaid.
A former state official had raised alarms several years ago about how Horizon was handling a state contract to administer billions of dollars in payments to hospitals and doctors. Horizon is New Jersey’s largest health insurer, covering about 3.7 million people.
The official, Christin Deacon, filed a whistleblower lawsuit along with others seeking to recover money from Horizon on behalf of New Jersey. The case remained under seal before the resolution was disclosed in court filings on Friday.
Horizon denied that it engaged in fraud as part of the settlement. The company accused Platkin of “mischaracterizing and distorting facts to...
For decades the False Claims Act (FCA) was invoked against overbilling, kickbacks, defective pricing and other “classic” fraud against government programs primarily by health care providers, defen...