Broken down by year, Horizon BCBSNJ’s SIU has recovered or saved the following amounts:
• 2009 - January through May - $10.2 million.
• 2008 - $20.1 million.
• 2007 - $19.1 million.
• 2006 - $17.6 million

In 2006, Horizon BCBSNJ’s SIU received the “Excellence in Investigating Fraud Award” from the New Jersey Attorney General’s Office for its diligence in preventing and uncovering health care fraud.

“I would advise anyone considering defrauding our company to think again before engaging in such criminal activity,” said Douglas Falduto, Director of Horizon BCBSNJ’s Special Investigation Unit.  “We have a very skilled staff that is dedicated to detecting fraud in the system and determining who was involved.  Once the fraud is discovered, we refer it to the State Attorney General’s office for prosecution. Many people wind up in jail for health care fraud.”

Almost 70 percent of the fraud cases investigated by Horizon BCBSNJ are detected by Horizon BCBSNJ employees or by our members who contact the company.  The company has established an Anti Fraud hotline at 1-800-624-2048 that people can call if they suspect billing fraud. 

“Health care fraud is not a victimless crime.  Higher costs increase health insurance premiums and that results in more uninsured individuals,” noted Falduto.

The National Health Care Anti-Fraud Association (NHCAA) estimates conservatively that 3% of all health care spending—or $68 billion—is lost to health care fraud. That’s more than the gross domestic product of 120 different countries, including Iceland, Ecuador, and Kenya. 

About Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey is the oldest and largest health insurer in the state serving over 3.6 million members. Horizon BCBSNJ is New Jersey's only not-for-profit, health services corporation and is headquartered in Newark with offices in Wall, Mt. Laurel, and West Trenton.  
      
Horizon BCBSNJ provides a broad array of health and dental insurance products and services for individuals and small and large companies, including national companies headquartered in New Jersey.  Horizon BCBSNJ is committed to improving the health care experience for all the communities we serve as well as helping our members become and stay healthy.

Horizon BCBSNJ’s Web site is located at www.HorizonBlue.com. Horizon BCBSNJ is independent licensee of the Blue Cross Blue Shield Association