Blue Cross Overcharges State, Gets to Stay (Because Why Not?), Potter Warns Big Insurers' Self-Dealing Empire Is Crumbling, and Cigna Promises Simplicity Through AI and Copays

Hey all,

Happy Hump Day! Accountability in healthcare is whatever happens after you've already made the money. Horizon Blue Cross just settled a $100 million fraud case for overcharging New Jersey—and promptly kept their contract to keep managing those same benefits—while Cigna launched a "transparent" new health plan promising upfront pricing and simplified costs, which would be more convincing if their track record didn't suggest transparency is something you announce rather than deliver. The pattern is consistent: do whatever you want, pay the fine if you get caught, launch a transparency initiative, repeat. 

Enjoy the rundown!

Jacob Brody (Co-founder & CEO, ZorroRX)

(BenefitsPro) Horizon Blue Cross Blue Shield False Claims Settlement

Horizon Blue Cross Blue Shield of New Jersey has agreed to a $100 million settlement after being accused of fraudulently overcharging the state for health care claims under a 2020 contract to manage benefits for over 750,000 public employees and retirees. Filed under the New Jersey False Claims Act by private whistleblowers, the case underscores growing concerns about insurer accountability and transparency in public contracts, with state officials alleging Horizon knowingly violated contract terms to inflate payments. That being said, Horizon is still doing business with New Jersey—because nothing says "healthy working relationship" like a $100 million fraud accusation and a renewed contract. Full Article.

(Health Care Un-Covered) and (UnitedHealth, Cigna and Elevance's House of Cards Is Wobbling): According to Wendell Potter, UnitedHealth, Cigna, and Elevance are cracking down on independent physicians, slashing payments, and threatening hospitals to prop up profits as enrollment stalls and margins shrink. The article argues that their reliance on vertical integration and Medicare Advantage overpayments has turned once-dominant insurers into fragile conglomerates, increasingly dependent on internal deals and taxpayer dollars. Like a Jenga tower built from intercompany invoices, the same self-dealing that helped them rise now leaves them too entangled to pivot without knocking the whole thing over. Full Article

(Fierce Healthcare) Cigna’s New Transparent Health Plan Launch

Cigna Healthcare has introduced Clearity, a new employer-sponsored health plan that replaces deductibles and coinsurance with a tiered copay-only model, aiming to simplify costs and improve transparency through AI-powered tools. Designed to meet rising demands for price clarity and user-friendly care navigation, the plan provides upfront pricing, verified provider reviews, and broad access via Cigna’s Open Access Network. Employers can choose from five packages without compromising network flexibility, while members get digital support via an AI assistant to better understand benefits and make informed choices. Clearly, this is going to be an affordable plan that has transparency, open networks, and low costs all baked together—if you believe that, I have some magic beans I’d like to sell you. Full Article