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Horizon Blue Cross Blue Shield of New Jersey Reorganization Goes to the Governor

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the staff of the Ridgewood blog

Newark NJ, new legislation allowing Horizon Blue Cross Blue Shield of New Jersey to change its corporate form to a more modern structure  and one that would enable the nonprofit to invest a far greater amount into emerging technologies — passed in the NJ Senate and General Assembly on Thursday afternoon.

Continue reading Horizon Blue Cross Blue Shield of New Jersey Reorganization Goes to the Governor

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Fort Lee Insurance Broker Admits Health Care Fraud

Horizon Blue Cross Blue Shield of New Jersey

the staff of the Ridgewood blog 

Fort Lee NJ, An insurance broker with an office in Fort Lee, New Jersey, today admitted defrauding Horizon Blue Cross Blue Shield, U.S. Attorney Craig Carpenito announced.

Lawrence Ackerman, 54, a resident of Old Tappan, New Jersey, pleaded guilty before U.S. District Judge Anne E. Thompson in Trenton federal court to a superseding information charging him with one count of health care fraud.

According to documents filed in this case and statements made in court:

Ackerman was the chief operating officer of Atlantic Business Associates (ABA) and Atlantic Medical Associates (AMA), two “shell” companies through which he marketed health insurance nationally to people who were not his employees and therefore ineligible for health coverage. During the month of January 2011, he delivered $481,500 in health care benefits to ineligible participants.

The count of health care fraud to which Ackerman pleaded guilty is punishable by a maximum penalty of 10 years in prison and a fine of $250,000. Ackerman was originally charged in a two-count indictment with conspiracy to defraud Horizon Blue Cross Blue Shield of $5.6 million and the welfare fund of Local 2326 of $1 million in fraudulent health care claims. Under terms of the plea agreement, Ackerman will be responsible for making full restitution to Horizon and to the union’s benefit plan for their losses. Sentencing is scheduled for March 20, 2019.

U.S. Attorney Carpenito credited special agents of the Department of Labor, Office of the Inspector General, under the direction of Special Agent in Charge Michael Mikulka; agents of the Office of Employee Benefit Security Act (EBSA), under the direction of Regional Director Darren Cohen; and agents of the Office of Labor Management Standards (OLMS), under the supervision of Regional Director Andriana Vamvakas.

The government is represented by Senior Litigation Counsel V. Grady O’Malley of the Organized Crime/Gangs Unit and Assistant U.S. Attorney Sammi Malek of the Narcotics/OCDETF unit in Newark.

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Lower-cost plan a hit with consumers, but litigating hospitals say Omnia gave preferential treatment to large facilities

Nearly 18 months after they filed suit against Horizon Blue Cross Blue Shield to reveal details of how it formed its Omnia insurance network, hospital leaders and their attorneys may get to review documents and correspondence they believe are at the heart of their case.

But officials with Horizon, the state’s largest health insurance provider, said the drawn-out litigation is only distracting from more important battles: protecting federal funding for healthcare and working together to control costs while improving patient care.