New Jersey’s largest health care insurer will pay the state a record-breaking $100 million settlement. Attorney General Matt Platkin says the agreement with Horizon Blue Cross Blue Shield, an underwriter of NJ Spotlight News, settles allegations the company fraudulently secured a 2020 contract to deliver public employee health benefits, and overcharged the state for years.
The years-long probe focused on a condition that required Horizon to bill the state the lower amount between what a provider charged and the insurer’s negotiated rate. State investigators say Horizon promised to follow that rule, but never intended to and allegedly vowed to reimburse the state “only if they got caught.” The investigation also revealed the insurance giant submitted more than 1,000 false claims, billing the higher amount and issuing inaccurate explanation of benefits statements.
Platkin says that fraudulent move drove up health care costs for hundreds of thousands of public servants in the state. As part of the settlement Horizon must pay the full $100 million within the next 25 days, comply with strict monitoring and reporting requirements and stop the fraudulent billing. Platkin added that the funds will be used to mitigate the damage to the state’s health benefits plan, that’s faced significant financial turmoil this year.
A representative for Horizon disputed Platkin’s characterization of the dispute, telling the NJ Monitor that the company had worked to resolve the disagreement.
“...
overcharged the U. S. Department of Homeland Security for aviation contracts, federal prosecutors said Friday. . . . Law360 is on it, so you are, too. A Law360 subscription puts you at the center o...