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

Massachusetts has change into the newest state to settle with medical insurance big Centene Corp. over allegations that it overbilled the state’s Medicaid program for pharmacy providers, KHN has realized.

Centene, the nation’s largest Medicaid managed-care insurer, pays $14.2 million, in keeping with Massachusetts Lawyer Normal Maura Healey. An official announcement is anticipated 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 a press release. “We’re happy to safe these funds to assist management Medicaid prices and be certain that state sources 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 practically $166 million.

“This no-fault settlement displays the importance we place on addressing their considerations and our ongoing dedication to creating the supply of healthcare native, easy and clear,” Centene stated in a press release emailed to KHN. “Importantly, this permits us to proceed our relentless concentrate on 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 corporations similar to Centene additionally administer Medicaid enrollees’ prescription drugs by what is named a pharmacy profit supervisor. These profit 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 keeping with the lawyer basic’s workplace.

A evaluate by Healey’s workplace discovered “irregularities within the pricing and reporting of pharmacy advantages and providers” 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 pharmaceuticals and pharmacy providers. However the whole variety of states is just not publicly recognized as a result of most of the settlement negotiations are carried out behind closed doorways. Some states, similar to 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 keeping with information releases and settlement paperwork from attorneys basic in these states. The Massachusetts settlement, which was signed Sept. 23, brings Centene’s pharmacy providers settlement whole to not 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 keeping with a July submitting with the U.S. Securities and Change 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 generally have drawn growing scrutiny and criticism. The Federal Commerce Fee introduced in June that it was launching an investigation into the pharmacy profit administration trade and its influence on client entry to pharmaceuticals and drugs prices.

This story was produced by KHN (Kaiser Well being Information), a nationwide newsroom that produces in-depth journalism about well being points. Along with Coverage Evaluation and Polling, KHN is among the three main working packages at KFF (Kaiser Household Basis). KFF is an endowed nonprofit group offering info on well being points to the nation.

KHN (Kaiser Well being Information) is a nationwide newsroom that produces in-depth journalism about well being points. Along with Coverage Evaluation and Polling, KHN is among the three main working packages at KFF (Kaiser Household Basis). KFF is an endowed nonprofit group offering info on well being points to the nation.

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