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Lawsuit: Horizon Misled on How it Selected N.J. Hospitals for Top Insurance Tier

Posted in Hospitals and Institutions, Litigation, Private Insurers, State Matters

Day Pitney’s Mike Furey was quoted in a June 4 article, “Lawsuit: Horizon misled on how it selected N.J. hospitals for top insurance tier,” in the Star-Ledger and NJ.com. Day Pitney is representing six New Jersey hospitals in a lawsuit against Horizon Healthcare concerning its new, multi-tiered health plan called OMNIA.

Day Pitney obtained court orders compelling Horizon to hand over documents revealing that the six hospitals suing Horizon met all of Horizon’s criteria and standards to be Alliance Partners and Tier 1 hospitals, according to the amended complaint in the case. The lawsuit claims that instead of using a “pass or fail” score on quality measures to determine which hospitals should be Alliance Partners and Tier 1 or 2 hospitals, Horizon chose the largest and most expensive hospitals in its network to be its partners as a way to cause these hospitals to reduce their charges to Horizon. By Horizon labeling the six hospitals as “Tier 2,” their reputations were allegedly damaged.

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