Day Pitney's Michael Furey was quoted in a Politico
article about two hospitals that will be downgraded to second-tier
status by New Jersey's largest insurer, Horizon Blue Cross Blue
Shield of New Jersey, in its value-based health plan called OMNIA.
The status level of a hospital in the two-tiered ranking system is
of "particular importance," according to the article,
because the plan encourages customers to choose Tier 1 hospitals
and doctors.
Day Pitney is representing three other New Jersey hospitals in a
lawsuit against Horizon Healthcare relating to its OMNIA health
plan. While neither of the hospitals whose status is being changed
is involved in the lawsuit, according to the article, the plan to
downgrade them "is sure to raise new questions about the
validity of Horizon's selection criteria." In the article,
Mike said, "This tier reshuffling suggests the selection
process was not as thoughtful as Horizon has claimed." He
continued, "It is also at odds with Horizon's contention
in the litigation where my clients seek Tier 1 designation that it
cannot add new Tier 1 hospitals."
Mike and Dennis LaFiura are representing three of the plaintiff
hospitals - CentraState Medical Center in Freehold, Holy Name
Medical Center in Teaneck, and Valley Hospital in Ridgewood. The
case, Centrastate Medical Center Inc. et al v. Horizon
Healthcare Services Inc., is pending in the Superior Court of
New Jersey, Chancery Division.
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