Jersey City has launched an independent audit of health insurance claims paid during the tenure of its previous contract with Horizon Blue Cross Blue Shield of New Jersey, Mayor James Solomon announced Tuesday. The move, part of a broader effort to rein in rising healthcare costs, aims to determine whether the city overpaid for services and potentially recover funds. The audit comes shortly after the city transitioned its employee health plan to Aetna, a move officials project will save approximately $30 million annually.
The audit will encompass all claims processed under the prior agreement with Horizon, according to city officials. “The previous administration underbudgeted and delayed $52 million in health care bills and never once asked where all that money was going,” Solomon stated. “We believe there is significant money owed to Jersey City taxpayers. We intend to get it back.” The mayor characterized the previous approach to healthcare spending as one of “financial indifference,” stating that the city had historically paid Horizon’s bills without scrutiny or independent verification.
Transition to Aetna and Financial Oversight
The decision to switch health insurance providers from Horizon to Aetna was made earlier this year, with the goal of both reducing costs and maintaining or improving benefits for city employees. Finance Director William Viqueira, appointed by Solomon after a three-decade career in public and private finance—including roles as CFO and treasurer of NJ Transit—is leading the effort to strengthen financial oversight within the city.
Under the terms of its agreement, Horizon Blue Cross Blue Shield is legally obligated to fully cooperate with the audit and to reimburse the city for any funds identified as having been improperly paid. The Solomon administration expects to complete the audit within approximately two months.
Horizon’s Response
In a statement provided to NJBIZ, Horizon Blue Cross Blue Shield defended its past performance, stating, “Since our founding nearly 100 years ago, Horizon has had a long and positive history of partnering with employers across New Jersey. Those partnerships, built on a hard-earned foundation of integrity and trust, have provided best-in-class service and unsurpassed access to high quality health care for millions of public and private employees while saving them, and their employers, billions of dollars.” The company added that “The claims processed for Jersey City were paid according to the contracts in place with the providers who filed them.”
The audit of past claims represents a significant shift in Jersey City’s approach to healthcare spending, signaling a commitment to greater financial accountability, and transparency. The Solomon administration has indicated it intends to publicly release the audit’s findings, including any recovered funds, once the review is complete. Residents can find updates on the city’s website at www.jerseycitynj.gov.
Disclaimer: This article provides information about municipal financial matters. It is not financial advice. Consult with a qualified professional for personalized guidance.
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