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.
Recipients initially filed the suit under the New Jersey False Claims Act, which allows private citizens to pursue claims on the state’s behalf, receiving a portion of any settlement. Five relators will share $12 million awarded in the settlement, while the remainder of the funds will support NJ’s pension system and false claims enforcement.
Under the rules of the settlement, Horizon must make the $100 million payment by early December, providing additional reporting of its claims and financial data. The insurer is also responsible to cover attorney fees and other costs tied to the agreement.
Officials emphasized that enforcing contracts and protecting public health benefits remains a top priority for the state. The resolution closes a legal dispute between Horizon and New Jersey, while ensuring that oversight mechanisms are strengthened for the future.
The New Jersey Digest is a new jersey magazine that has chronicled daily life in the Garden State for over 10 years.