Another day, another massive healthcare settlement in the state of New Jersey.
Horizon Blue Cross Blue Shield will pay the state $100 million to resolve allegations that it overcharged on public worker health plans. The settlement follows claims that the insurer ignored contract provisions designed to alleviate costs and submitted inaccurate billing information that resulted in overcharging. Horizon denies wrongdoing and says the matter is merely a contract dispute.
According to reporting by New Jersey Monitor, the dispute centered on a 2020 contract that required Horizon to charge the lesser of a provider’s billed amount. State officials alleged the company knew it could not comply with the provision but failed to disclose that during contract negotiations. The settlement is record-breaking and marks the largest false claims resolution in state history that’s not related to Medicaid.
The state said Horizon collected approximately $500 million in the five years under the contract in a statement released by Attorney General Matthew Platkin’s office. The company, which manages coverage for more than 750,000 state and local employees and retirees, has since adjusted its practices to follow the lesser-of provision—no longer sending misleading statements to plan members.
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