TRENTON — Horizon Blue Cross Blue Shield of New Jersey will pay the state $100 million to settle allegations it fraudulently secured a 2020 contract to administer public employee health benefits and then overcharged the state for years, Attorney General Matthew J. Platkin announced Friday.
The settlement — New Jersey’s largest-ever non-Medicaid False Claims Act recovery — resolves claims that Horizon violated the state False Claims Act by misleading officials during the bidding process and submitting false claims after winning the multibillion-dollar contract.
State officials say Horizon knowingly ignored a cost-saving “lesser of” provision requiring the insurer to bill the state the lower amount between a provider’s charge and a negotiated rate. Investigators allege Horizon promised compliance to secure the contract, then billed higher amounts and sent inaccurate Explanation of Benefits statements to members.
“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,” Platkin said.
Treasurer Elizabeth Maher Muoio praised the Division of Pensions and Benefits, which began probing the issue in 2021 after concerns about contract violations surfaced.
The state’s complaint, unsealed Friday along with the settlement, details more than a thousand alleged false claims and false records submitted by Horizon. The company received nearly $500 million in administrative fees...
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