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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.