Horizon Blue Cross Blue Shield agreed to pay New Jersey $100 million as part of a settlement to resolve claims that it made false statements to win a contract managing the state’s public worker health plans and then ignored a contractual provision so it could overcharge the public plans, prosecutors announced Friday.
State officials say Horizon, which administers public plans that insure more than 750,000 state and local government workers and retirees, had ignored a provision in the 2020 contract that required it to charge the state the amount billed by a health care provider or an amount negotiated between the provider and Horizon, whichever is less.
But the insurer knew it could not comply with the provision before it bid into the contract and concealed that fact from state procurement officials, the Office of the Attorney General alleged. Then it ignored the provisions, submitting more than 1,000 false claims to the state alongside fraudulent records to support them, according to state prosecutors.
“At a time when everyone is rightly concerned about the cost of their health care, it is simply unacceptable that an insurance company would seek to defraud our State and overcharge us while driving up the costs of health care for hundreds of thousands of dedicated public servants,” Attorney General Matt Platkin said in a statement Friday.
The state said Friday the settlement is the largest non-Medicaid false claims settlement amount in state history. Horizon denies any...
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...