Massachusetts is the latest state to deal with health insurance giant Centene Corp. on allegations that he overtaxed the state’s Medicaid pharmacy service program, KHN has learned.
According to Massachusetts Attorney General Maura Healey, St. Louis-based Centene, the nation’s largest Medicaid managed care insurer, will pay $14.2 million.
“This settlement is a significant result of our work to protect taxpayers’ money and the integrity of our MassHealth program,” Healey said in a statement. “We are pleased to secure these funds to help control Medicaid costs and ensure government resources are put to the best possible use in our healthcare system.”
Centene on Wednesday denied wrongdoing in Massachusetts, as has been the case in previously announced settlements. KHN reported earlier this month that Centene agreed to pay Texas in July nearly $166 million.
“This no-fault agreement reflects the importance we place on addressing their concerns and our ongoing commitment to make healthcare delivery local, simple and transparent,” Centene said in a statement emailed to KHN was sent. “Importantly, this allows us to remain relentlessly focused on delivering quality results to our members.”
Centene provides health coverage to 15.4 million Medicaid members nationwide by contracting with states to cover people with disabilities or low-income families. The St. Louis-based insurer makes about two-thirds of its revenue from Medicaid, which is jointly funded by state and federal taxpayers.
In many states, insurance companies like Centene also manage Medicaid members’ prescription drugs through what is called a pharmacy benefit manager. These benefit managers act as middlemen between drug manufacturers and health insurance companies and as an intermediary between health insurance companies and pharmacies.
CeltiCare, a subsidiary of Centene, offered Medicaid coverage to Massachusetts policyholders until the state began revising its program. Centene also administered pharmacy services for the state’s Medicaid program, MassHealth, according to the attorney general’s office.
A review by Healey’s office found “irregularities in the pricing and reporting of pharmacy benefits and services” by Centene’s pharmacy benefits manager, Envolve Pharmacy Solutions, the statement said.
Several states have settled with Centene’s pharmacy manager business over allegations that it overrated its Medicaid programs for prescription drugs and pharmacy services. The total number of states is not publicly known, however, as many of the settlement negotiations are conducted behind closed doors. Some states like California have investigated the company, KHN first reported in April.
Prior to the Massachusetts Accord, Centene had settled deals totaling $475 million with Arkansas, Illinois, Kansas, Mississippi, New Hampshire, New Mexico, Ohio, Texas and Washington, according to press releases and settlement documents from those states’ attorneys general. The Massachusetts settlement, signed Sept. 23, brings Centene’s pharmacy services settlement to at least $489 million. Other states have also come to terms with Centene, but the settlement amounts — and the states themselves — have not been publicly disclosed.
According to a, Centene committed $1.25 billion in 2021 to resolve the pharmacy benefit manager settlements in “affected states.” Submission in July with the US Securities and Exchange Commission, which didn’t say how many states.
Florida and South Carolina have signed legal agreements with a Mississippi-based firm, Liston & Deas, which has represented other states in their Centene pharmacy service investigations.
Pharmacy service administrators in general have attracted increasing attention and criticism. The Federal Trade Commission announced in June that it initiated an investigation into the pharmacy benefit management industry and its impact on consumer access to prescription drugs and drug costs.
KHN (Kaiser Health News) is a national newsroom producing in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major operational programs at KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the nation.
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https://fox2now.com/news/missouri/centene-agrees-to-pay-massachusetts-14-million-over-medicaid-prescription-claims/ Centene agrees to pay Massachusetts $14 million for Medicaid prescription claims