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Court reaffirms what a complaint must allege under the New Jersey Insurance Fraud Prevention Act to survive a motion to dismiss.

April 1, 2018
Horizon Blue Cross Blue Shield of N.J. v. Focus Express Mail Pharm., Inc., 2017 U.S. Dist. LEXIS 131013

The plaintiff brought a complaint against a mail order pharmacy alleging violations under the New Jersey Insurance Fraud Prevention Act (NJIFPA), alleging that it paid in excess of $10 million to the defendant, an unlicensed mail order pharmacy in New Jersey. The court reaffirmed that to allege a claim under the NJIFPA, the plaintiff must allege: (1) knowledge, (2) falsity, and (3) materiality. Unlike common law fraud, proof of fraud under the IFPA does not require proof of reliance on a false statement, resultant damages or proof of intent to deceive. Given the heightened pleading standards under the IFPA, insurance carrier’s complaints must make sure that a complaint states a plausible claim under all three prongs to survive a motion to dismiss.


Case Law Alerts, 2nd Quarter, April 2018

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