Horizon BCBSNJ's $100 million False Claims Act settlement

Originally posted November 14, 2025 by Chris Vanderwolk

Wow. $100,000,000.00

That’s how much Horizon Blue Cross Blue Shield of New Jersey agreed to pay to settle their false claims act suit brought for programmatic overpayment of providers.

It’s an eye watering amount of money and it’s only based on the failure to operationalize the “lesser of” contract provision.

Grateful for the AG Matthew Platkin for taking action here.

Thanks to Kevin Lyons, Chris Deacon, Patrick Colligan, Marc Kovar, and Vincent Flores for bringing the case.

If they’ll do it to the state of New Jersey, what would anyone think it couldn’t happen to them?

Read your contracts. Get your data. Only pay what you actually owe.

https://lnkd.in/eV7j5e-G

Originally posted on LinkedIn, where the discussion and source links live in the comments.

About the author

Chris Vanderwolk is Director of Compliance and Innovation at OneDigital | Kistler Tiffany Benefits General Agency, where he helps brokers and employers navigate the regulatory complexity of employee benefits. An ERISA attorney with more than 19 years in the benefits industry, he specializes in translating what the law actually requires into language people can use.