NEW JERSEY (KYW Newsradio) — Health care insurance provider Horizon Blue Cross Blue Shield has agreed to pay a $100 million settlement to New Jersey after the company was caught overcharging for state employee doctor visits.
In 2019, Horizon won a contract to run the state employee health care plans. One of the provisions was that the company couldn’t bill more for a doctor visit than the doctor actually charged. Attorney General Matt Platkin said the company knowingly and repeatedly violated this, and internal emails showed they had a backup plan if they were caught over-billing.
“They hoped we wouldn’t notice, and now they are paying a significant and historic price,” Platkin said, adding that Horizon executives knew they couldn’t abide by the contract.
“It bid on the contract anyway and won by tricking the state into believing that Horizon was ready, willing and able to comply with this lesser of provision and save the state money.”
Horizon said this was nothing more than a contract dispute over a minuscule portion of the millions of claims processed and that the company has been negotiating in good faith to resolve the matter. The company never retained any of this money, and Horizon was selected as the administrator again in 2024.
The $100 million settlement is the largest of its kind in state history, and Platkin says the vast majority of the money will be returned to the health fund to cover costs.