Greater than three years in the past, medical insurance big Centene Corp. settled allegations that it overcharged Medicaid applications in Ohio and Mississippi associated to prescription drug billing.
Now at the least 20 states have settled with Centene over its pharmacy profit supervisor operation that coordinated the drugs for Medicaid sufferers. Arizona was among the many most up-to-date to hitch the ranks, settling for an undisclosed payout, Richie Taylor, a spokesperson for the state’s lawyer basic, informed KFF Well being Information in December.
All informed, Centene has agreed to pay greater than $1 billion in settlements, in line with Cohen Milstein, one of many regulation corporations representing states within the agreements. In the meantime, St. Louis-based Centene reported $163 billion in income in 2024, largely proceeds from authorities well being applications for Medicaid, Medicare, and the Reasonably priced Care Act. The well being care firm has admitted no wrongdoing within the settlements.
Two state holdouts seem to stay: Georgia has but to settle with Centene, despite the fact that the administration of Gov. Brian Kemp employed regulation agency Liston & Deas in 2019 to research state pharmacy profit operations.
Florida employed the identical regulation agency in 2021 to pursue overbilling allegations involving Centene, however state officers declined to reply a reporter’s questions on whether or not Florida has dropped the case, reached an undisclosed settlement, or continues to be discussing the problem.
Neither state has publicly disclosed what’s standing in the best way of probably tens of thousands and thousands of {dollars} in Centene payouts, or whether or not negotiations are going down. As a result of the offers are largely occurring exterior the courtroom system, the method between the non-public regulation corporations employed by states and Centene stays usually out of public view.
Centene spokespeople didn’t return a number of telephone calls and emails asking for updates. In 2022, the corporate stated it was engaged on settlements with Georgia and eight different states, having reached offers with 13 others. And in a Securities and Change Fee submitting in October, Centene stated it had reached settlements with “the overwhelming majority of states impacted” over the operations of its former pharmacy advantages supervisor.
Georgia has “taken disproportionately lengthy in comparison with different states,” stated Greg Reybold, a vp of the American Pharmacy Cooperative, which represents unbiased pharmacies.
In the meantime, Centene’s Georgia Medicaid plan, the Peach State Well being Plan, misplaced its bid final 12 months to proceed its longtime participation in a Georgia Medicaid program wherein corporations cowl the care for Medicaid recipients for a set payment from the federal government slightly than for every medical service supplied. The corporate, which has been a part of the contract because the managed-care program started in 2006, filed a protest over the contract awards, saying that the method was “mismanaged, rife with errors and reckless practices.”
Nationally, pharmacy profit managers, or PBMs, have come below elevated scrutiny over accusations of pocketing reductions on drugs or inflating prices within the years since Centene began settling its Medicaid-related allegations. Members of Congress have proposed main coverage constraints on PBMs. Centene has since overhauled its PBM operation.
Nonetheless, a attainable settlement in Georgia may herald important cash to the state. California had the most important publicly disclosed settlement at $215 million, cut up with the federal authorities, however a settlement with Georgia could possibly be within the vary of the $88 million that Centene agreed to pay within the Ohio dispute, Reybold stated.
The state ought to aggressively pursue a settlement with Centene, stated Roland Behm, co-founder of the Georgia Psychological Well being Coverage Partnership, who’s a critic of Centene and its Georgia Medicaid plan. Behm stated state Lawyer Common Chris Carr ought to take “the identical tenacious prosecutorial motion” in opposition to Centene that Carr’s company takes in opposition to people concerned in fraud in opposition to Medicaid, the federal-state program that gives medical insurance protection for these with low incomes or disabilities.
Carr’s workplace stated in 2022 that it stood able to signify Georgia in settlement negotiations with Centene. Carr, a Republican who has introduced he’s working for governor in 2026, obtained tens of hundreds of {dollars} in marketing campaign contributions from Centene, its subsidiaries, and its executives, as did Kemp, a fellow Republican, KFF Well being Information reported in 2022. Contributions to the Kemp and Carr campaigns have been a part of greater than $26.9 million that Centene, its subsidiaries, its prime executives, and their spouses donated to state politicians in 33 states, to their political events, and to nonprofit fundraising teams from 2015 by means of 2022.
Since 2022, the corporate and its political motion committee have contributed, mixed, at the least $2 million extra to the campaigns of Florida and Georgia candidates of each political events, together with state celebration organizations and political committees, in line with state marketing campaign finance data.
When requested a few attainable settlement, a spokesperson for Carr, Kara Murray, directed a reporter to the Georgia Division of Neighborhood Well being, which administers Medicaid.
Fiona Roberts, a spokesperson for that company, then informed KFF Well being Information that the division “is actively pursuing choices to make sure regulatory compliance with the state’s contract.” She declined to remark additional.
Florida’s lawyer basic’s workplace directed a reporter to the state company that oversees Medicaid, the Florida Company for Well being Care Administration. However that company didn’t reply to a number of telephone calls and emails requesting remark.
Rebecca Grapevine of Healthbeat contributed to this text.
