New Jersey won't claw back $34M from Horizon BCBS over alleged undelivered services

New Jersey state officials are no longer looking to claw back $34 million from Horizon Blue Cross Blue Shield of New Jersey for a service that allegedly was not provided to state employees through their health plan, Bloomberg reported June 21.

The state's treasury department oversees the health plan for New Jersey employees. Last year, the office said the state should fight to get back $34 million from Horizon regarding a new navigation program that was intended to help enrollees find better care for lower costs. At the time, the health plan was overseen by former treasury department employee Christin Deacon.

Ms. Deacon said she and others tested the new service after its debut and found Horizon was not delivering. An audit of the new health guide showed it was similar to the payer's standard customer service.

After asking Horizon to fix the problem for months, Ms. Deacon said she filed an internal complaint about the issue, asked the company to refund its investment, and requested a response by June 7, 2021.

Just before a response was due, Ms. Deacon said Gov. Phil Murphy's office wanted the complaint withdrawn. A meeting with Horizon executives and state officials was scheduled for June 29, 2021. Since that meeting, the complaint has gone nowhere. It is currently unclear whether the state believes the terms of its contract with Horizon are being met or if the health guide service is still being paid for, according to Bloomberg. 

"It is our fiduciary obligation," Ms. Deacon wrote in a memo last summer, "to pursue these claims in a meaningful way." She resigned shortly after. 

Horizon's contract is worth about $136 million annually and has provided health coverage to state employees since 1996.

A spokesperson for the governor's office declined to comment on the complaint process or the June 29 meeting. A spokesperson for the New Jersey Treasury Department also declined to answer Bloomberg's questions about the complaint. 

A Horizon spokesperson told Bloomberg it "disagrees with and has responded to" the complaint and is working with the state to resolve any disagreements over the employee plan.

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