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Lawsuit: Horizon misled on how it selected N.J. hospitals for top insurance tier

Publisher: NJ.com
June 4, 2016

Michael Furey was quoted in an 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, relating to its new, multi-tiered health plan called OMNIA. Day Pitney obtained court orders compelling Horizon to hand over documents that revealed 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. 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 suffered a blow, according to the lawsuit.


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