Avym, along with the State of New Jersey, acting through the New Jersey Attorney General Matthew J. Platkin, announced today that Horizon Healthcare Services, Inc. has agreed to pay $100 million to settle a lawsuit McKool Smith filed in 2021 on behalf of several whistleblowers, including Avym principals and founders Mark Flores, and Vince Flores.
The suit, brought under the qui tam provisions of the Federal False Claims Act (FCA) and the New Jersey False Claims Act, alleges that Horizon defrauded the New Jersey State Health Benefits Program and the State Employee Health Benefit Plan (“State Benefit Plans”).
The allegations relate to Horizon’s role administering the medical benefits of hundreds of thousands of New Jersey government employees. Horizon submitted false funding claims to the State for years, costing taxpayers hundreds of millions of dollars.
This case involved allegations of a multi-year scheme by Horizon to take New Jersey taxpayer money from State employee and school health benefit plans.
Mark Flores, a nationally recognized health benefits consultant, expressed his thanks to the Office of the Attorney General. “We would like to thank Attorney General Platkin and the devoted lawyers in the Government and Healthcare Fraud Unit for paying attention to this important issue, for investigating our allegations, and pursuing the claims to protect State Health Plan members and New Jersey taxpayers.” Vince Flores, a health benefits consultant, followed, “We hope this settlement will cause Horizon and other health insurers to examine how they administer self-funded plans.”
All “Relators” include Mark Flores, Vince Flores, Chris Deacon, Kevin Lyons, Pat Colligan & Marc Kovar
Link to Complaint: https://www.njoag.gov/wp-content/uploads/2025/11/2025-1114_NJ-US-ex-rel-Lyon-v-Horizon_Complaint-in-Intervention.pdf
Link to Settlement Agreement: https://www.njoag.gov/wp-content/uploads/2025/11/2025-1114_NJ-ex-rel-Lyons-v-Horizon_Executed-Settlement-Agreement.pdf