KHN has learned that Massachusetts has become the latest state to reach a settlement with health insurance giant Centene Corp over allegations that it overpaid the state’s Medicaid program for pharmacy services.
Louis-based Centene, the largest managed care insurer in the United States, will pay $14.2 million, according to Massachusetts Attorney General Maura Healey. An official announcement is expected later Thursday.
“This settlement is an important finding in our work to protect taxpayer money and the integrity of our MassHealth program,” Healy said in a statement. “We are pleased to secure these funds to help control Medicaid costs and ensure that state resources are directed to the best possible uses in our health care system.”
Centene on Wednesday denied any wrongdoing in Massachusetts, as it has in previously declared settlements. KHN reported earlier this month that Centene I agreed in July to pay Texas Approximately 166 million dollars.
“This error-free agreement reflects the importance we place in addressing their concerns and our ongoing commitment to making healthcare delivery locally, simple and transparent,” Centene said in a statement emailed to KHN. “Most importantly, this allows us to continue our relentless focus on delivering high-quality results to our members.”
Centene provides health insurance to 15.4 million Medicaid enrollees nationwide by contracting with states to cover people with disabilities or from low-income families. The St. Louis-based insurer earns 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 administer prescription drugs to Medicaid enrollees through a so-called pharmacy benefits manager. These benefits managers act as intermediaries Between pharmaceutical companies and health insurance companies and as intermediaries between health plans and pharmacies.
Centene’s CeltiCare offered Medicaid enrollees in Massachusetts insurance until the state began reforming its program. Centene also administered pharmacy benefits to the state’s Medicaid program, MassHealth, according to the attorney general’s office.
A review by Healey’s office found “irregularities in pricing and reporting of pharmacy benefits and services” by Centene’s director of pharmacy benefits, Envolve Pharmacy Solutions, its statement said.
Multiple states have settled with Centene’s pharmacy director business over allegations that it over-billed its Medicaid programs for drugs and pharmacy services. But the total number of countries is not publicly known because many settlement negotiations are taking place behind closed doors. Some states, such as California, are investigating the company, KHN first reported in April.
Prior to the Massachusetts agreement, Sentin had settled with Arkansas, Illinois, Kansas, Mississippi, New Hampshire, New Mexico, Ohio, Texas and Washington for a total of $475 million, according to news data and settlement documents from attorneys general in those states. The Massachusetts settlement, signed Sept. 23, brings the Centene Pharmacy services settlement total to at least $489 million. Other countries have also settled with Centene, but the settlement amounts – and the states themselves – have not been publicly disclosed.
Centene set aside $1.25 billion in 2021 to resolve the Pharmacy Benefit Administration receivable settlement in “affected states,” according to July deposit With the US Securities and Exchange Commission not specifying the number of states.
Florida and South Carolina have signed legal agreements with Mississippi-based Liston & Deas, which has represented other states in Centene’s pharmacy benefits inquiries.
Pharmacy benefits managers in general have come under increased scrutiny and criticism. Federal Trade Commission announced in June 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 that produces in-depth journalism on health issues. Along with policy analysis and survey, KHN is one of the three major drivers in KFF (Caesar Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.