Centene Corp. settles for $215 million on California Medicaid overbilling accusations

More than 20 states are investigating or have investigated Centene’s Medicaid pharmacy billing. The company also has agreed to pay settlements to at least 16 other states, including Illinois and Indiana.

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A Centene Corp. sign. California Department of Justice investigators found that Centene Corp. subsidiaries reported inflated drug costs and fees in providing prescription drugs to patients in Medi-Cal, the state’s Medicaid insurance program, from January 2017 to December 2018.

California Department of Justice investigators found that Centene Corp. subsidiaries reported inflated drug costs and fees in providing prescription drugs to patients in Medi-Cal, the state’s Medicaid insurance program, from January 2017 to December 2018.

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Centene Corp. has agreed to pay more than $215 million to California after being accused of overcharging the state for pharmacy services — the biggest payout to date by the nation’s largest Medicaid insurer over its drug pricing practices.

The agreement makes California at least the 17th state, Illinois and Indiana among them, to settle pharmacy billing claims totaling $939 million with the St. Louis insurance giant. Centene reported $144.5 billion in revenue in 2022, up 15% from the previous year.

Investigators with the California Department of Justice found that Centene’s subsidiaries reported inflated drug costs and fees in providing prescription drugs to patients in Medi-Cal, the state’s Medicaid insurance program for people with low incomes or disabilities, from January 2017 to December 2018.

“When companies overcharge the Medi-Cal system, it drains valuable resources from the people who rely on this care,” said California Attorney General Rob Bonta, a Democrat.

As it has in previous settlements, Centene denied wrongdoing.

In California, the insurer operates two subsidiaries: California Health & Wellness and Health Net, which together provide coverage to about two million Medi-Cal patients.

“This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making the delivery of healthcare local, simple and transparent,” Centene officials said in a written statement.

Most states contract with private insurance companies such as Centene to cover people in their Medicaid programs, which are jointly paid for by state and federal taxpayers. In many of those states, the insurance company also handles prescription medications through a pharmacy benefit manager, or PBM, to get lower prices. Such benefit managers act as intermediaries between drugmakers and health insurers and between health plans and pharmacies.

Bonta said Centene’s companies leveraged its pharmacy management contracts to save its California plans $2.70 per prescription drug claim over two years, but Centene and its PBM failed to disclose or pass on these discounted fees to Medi-Cal.

The $215 million settlement amounts to twice the value of Centene’s inflated prices, according to Bonta.

More than 20 states are investigating or have investigated Centene’s Medicaid pharmacy billing. Beside California, the company has agreed to pay settlements to at least 16 of those states: Illinois, Indiana, Arkansas, Iowa, Kansas, Louisiana, Massachusetts, Mississippi, Nebraska, New Hampshire, Nevada, New Mexico, Ohio, Oregon, Texas and Washington, according to statements and settlement documents from attorneys general in those states.

Centene provides benefits to 15.9 million Medicaid enrollees nationwide.

In California, Centene has spent at least $5 million on lobbying, political contributions and other contributions over the past five years, according to a KHN analysis of filings with the secretary of state and California Fair Political Practices Commission.

Last year, Centene protested the Medi-Cal contract awards, which would have significantly cut its business in the nation’s most populous state. State health officials changed course after Centene and other insurers threatened lawsuits, partially restoring some of its business.

A KHN investigation last year found that the company, its subsidiaries, its top executives and their spouses contributed more than $26.9 million to politicians in 33 states, to their political parties and to nonprofit fundraising groups from Jan. 1, 2015, through Oct. 4, 2022. The company focused its giving on states in which it has been wooing Medicaid contracts and settling accusations that it overbilled taxpayers.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues.

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