Centene Agrees to Pay Massachusetts $14 Million Over Medicaid Prescription Claims

Massachusetts has develop into the most recent state to settle with medical insurance big Centene Corp. over allegations that it overbilled the state’s Medicaid program for pharmacy companies, KHN has discovered.

Centene, the nation’s largest Medicaid managed-care insurer, pays $14.2 million, in response to Massachusetts Legal professional Basic Maura Healey. An official announcement is predicted later Thursday.

“This settlement is a big end in our work to guard taxpayer {dollars} and the integrity of our MassHealth program,” Healey stated in an announcement. “We’re happy to safe these funds to assist management Medicaid prices and make sure that state assets are directed to the absolute best makes use of in our well being care system.”

Centene on Wednesday denied wrongdoing in Massachusetts, because it has in beforehand introduced settlements. KHN reported earlier this month that Centene agreed in July to pay Texas almost $166 million.

“This no-fault settlement displays the importance we place on addressing their issues and our ongoing dedication to creating the supply of healthcare native, easy and clear,” Centene stated in an announcement emailed to KHN. “Importantly, this enables us to proceed our relentless give attention to delivering high-quality outcomes to our members.”

Centene gives medical insurance to fifteen.4 million Medicaid enrollees throughout the nation by contracting with states to cowl individuals who have disabilities or are in low-income households. The St. Louis-based insurer earns about two-thirds of its income from Medicaid, which is collectively funded by state and federal taxpayers.

In lots of states, insurance coverage firms resembling Centene additionally administer Medicaid enrollees’ prescription drugs by way of what is named a pharmacy profit supervisor. These benefit managers act as middlemen between drugmakers and well being insurers and as intermediaries between well being plans and pharmacies.

Centene’s CeltiCare subsidiary provided insurance coverage to Massachusetts Medicaid enrollees till the state started to overtake its program. Centene additionally administered pharmacy advantages for the state Medicaid program, MassHealth, in response to the lawyer normal’s workplace.

A overview by Healey’s workplace discovered “irregularities within the pricing and reporting of pharmacy advantages and companies” by Centene’s pharmacy advantages supervisor, Envolve Pharmacy Options, its assertion stated.

A number of states have settled with Centene’s pharmacy supervisor enterprise over allegations that it overbilled their Medicaid packages for prescribed drugs and pharmacy companies. However the whole variety of states will not be publicly identified as a result of most of the settlement negotiations are carried out behind closed doorways. Some states, resembling California, have been investigating the corporate, KHN first reported in April.

Earlier than the Massachusetts settlement, Centene had settled with Arkansas, Illinois, Kansas, Mississippi, New Hampshire, New Mexico, Ohio, Texas, and Washington for a complete of $475 million, in response to information releases and settlement paperwork from attorneys normal in these states. The Massachusetts settlement, which was signed Sept. 23, brings Centene’s pharmacy companies settlement whole to no less than $489 million. Different states have additionally settled with Centene, however the settlement quantities — and the states themselves — haven’t been publicly disclosed.

Centene put aside $1.25 billion in 2021 to resolve the pharmacy profit supervisor settlements in “affected states,” in response to a July filing with the U.S. Securities and Trade Fee that didn’t specify what number of states.

Florida and South Carolina have signed authorized agreements with a Mississippi-based agency, Liston & Deas, that has represented different states of their pharmacy profit inquiries into Centene.

Pharmacy profit managers normally have drawn growing scrutiny and criticism. The Federal Commerce Fee announced in June that it was launching an investigation into the pharmacy profit administration business and its affect on shopper entry to prescribed drugs and medicine prices.

This story was produced by KHN, which publishes California Healthline, an editorially unbiased service of the California Health Care Foundation.


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