Centene allegedly used its subsidiary PBM to overcharge the Bay State's Medicaid program.
Centene Corp. will pay Massachusetts $14 million to settle allegations that managed care insurer overcharged the MassHealth Medicaid plan.
It's the latest in a series of settlements with at least 12 states for St. Louis-based Centene, the nation's largest Medicaid managed care provider, with 15.4 million enrollees nationwide. Centene agreed to pay Texas $165 million in July for overcharges in a deal that wasn't make public until earlier this month.
Massachusetts Attorney General Maura Healey says her office looked into Centene's operations in her state, including its pharmacy benefits manager, Envolve Pharmacy Solutions, Inc., after other states discovered irregularities in pricing and reporting to MassHealth by Centene subsidiaries.
Healey's office alleges that Envolve and Centene failed to disclose or pass on some retail discount fees to MassHealth, which inflated fees and drug costs reported to the Commonwealth.
"This settlement is a significant result in our work to protect taxpayer dollars and the integrity of our MassHealth program," Healey says. "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 issued a statement admitting no wrong-doing and suggesting that the overcharges were unintentional.
"We respect the deep and critically important relationships we have with our state partners," the insurer says. "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. Importantly, this allows us to continue our relentless focus on delivering high-quality outcomes to our members."
“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, Corp.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
KEY TAKEAWAYS
Centene and subsidiary PBM Envision failed to disclose or pass on some retail discount fees to MassHealth, which inflated fees and drug costs.
It's the latest in a series of settlements with at least 12 states for St. Louis-based Centene, the nation's largest Medicaid managed care provider.
Centene agreed to pay Texas $165 million in July for overcharges in a deal that wasn't make public until earlier this month.
Centene issued a statement admitting to no wrong-doing and suggesting that the overcharges were not intentional.