N.J.’s Horizon Health Plan Settles with Cardiologists on Overpayments

March 9, 2006

New Jersey’s largest health insurer and two physician groups have settled a lawsuit over whether hundreds of heart specialists were overpaid for services performed in 2003 and 2004.

The settlement ends the case, which pitted the Medical Society of New Jersey and the American College of Cardiology’s New Jersey chapter against Horizon Healthcare Services Inc., which operates as Horizon Blue Cross Blue Shield of New Jersey.

Horizon claimed it mistakenly overpaid more than 600 cardiologists by a total of about $15 million for cardiac catheterizations, diagnostic procedures in which a flexible tube is threaded up into the heart; a camera or other instrument on the tip is used to look for blockages or other problems.

The medical society and the cardiologists group sued Newark-based Horizon in 2004 to stop it from withholding payments on current reimbursement claims by the doctors to offset the alleged overpayments. Horizon later stopped doing so.

Under the settlement, Horizon will recover “a mutually agreed-upon portion” of the $15 million, according to a joint press release from the insurer and the two doctors groups.

‘”We ultimately settled that for an amount less than $15 million,” said Steven Kern, an attorney for the medical society.

The exact amount is not being disclosed under an order by Superior Court Judge Alexander Lehrer, presiding judge of the Chancery Division in Monmouth County, who heard the case.

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