In Case You Missed It: New Jersey State Health Plan Wins $100M Settlement for Fraudulent Overcharges

The State of New Jersey just announced a $100 million settlement in a case regarding millions in fraudulent overcharges in their state employee health plan. As previously reported, whistleblowers came forward with "instances in which the state was paying hundreds of thousands over what was charged and one in which New Jersey paid 24 times the rate Medicare paid for the same service, far higher than the norm."  

In fact, in the "top 50 out-of-state claims... the state plan paid $18 million more than providers’ billed charge amount."  In one example, a patient's $674,856 dollar bill at New York Presbyterian was paid at more than $2 million.   

These were not isolated examples; they represent a systematic trend of fraudulent charges and demonstrate why employers and unions need access to claims data and full transparency into where the money is flowing.  

After years of overpayments, hidden charges, and taxpayers footing the bill for reckless greed, this $100 million settlement shows what accountability looks like. It is a major win for patients and the people of New Jersey, who all deserve fairness and integrity through transparency and accountability.

Read more from Bloomberg here. 

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PatientRightsAdvocate.org (PRA) is a leading national healthcare price transparency organization dedicated to ushering in systemwide transparency through advocacy, testimony, media, legal research, and grassroots campaigns. PRA believes that the availability and visibility of actual, upfront healthcare prices will greatly lower costs for patients and employers through a functional, competitive healthcare marketplace.