Post Retirement Benefit Costs Claimed by Horizon Blue Cross Blue Shield of New Jersey

EXECUTIVE SUMMARY:

The objective of  this review was to determine the allowability of $2,652,795 in Post Retirement Benefit (PRB) costs claimed for Medicare reimbursement by Horizon Blue Cross Blue Shield of New Jersey (Horizon).   The $2,652,795 represents PRB costs that will be incurred subsequent to the termination of Horizon's Medicare contract.  We found that Horizon's claim for $2,652,795 of PRB costs is unallowable for Medicare reimbursement.  We recommended that Horizon withdraw its claim for the $2,652,795 of unallowable PRB costs.  Horizon did not comment on our finding and recommendation.