State Steps In After DOJ Declines
After the U.S. Department of Justice declined to pursue the case, New Jersey intervened in federal court. The state’s newly unsealed complaint includes three counts under the New Jersey False Claims Act:
-
Fraudulent inducement
-
Submission of false claims
-
Submission of false records
The complaint also alleges breach-of-contract and unjust enrichment.
Horizon, the complaint says, discussed potentially issuing refunds if its overbilling was discovered, indicating awareness of the improper charges.
Historic Settlement
Attorney General Platkin highlighted the significance of the settlement, noting that it safeguards taxpayer dollars and underscores the state’s commitment to holding insurers accountable.
The resolution comes after years of scrutiny over how public-employee health plans are administered and billed, shining a light on systemic vulnerabilities in large-scale state contracts.
