Centene Corp (CC) reached a record settlement agreement Monday with Ohio for its alleged overbilling of the Ohio Department of Medicaid (ODM) for its pharmaceutical services.
America’s largest Medicaid managed care organization agreed to pay $88.3 million to Ohio after Dave Yost, the state’s attorney general, filed a lawsuit in March, according to a Yost press release.
“Centene used sophisticated moves to bill unearned dollars – moves known only at the top levels of health care companies,” Yost said. “It has taken a huge effort by my team to untangle this scheme – and now that we know how it works, the alarm bells should be ringing for anyone using similar tactics.”
According to the press release, the March lawsuit claimed that CC breached its contract with ODM by “filing reimbursement requests for amounts already paid by third parties,” “failing to accurately disclose to ODM the true cost of pharmacy services, including the disclosure of discounts received,” and “artificially inflating dispensing fees.”
“Centene took advantage of all of us who pay taxes to care for the most vulnerable Ohioans,” Yost said. “This settlement is the big first step Centene is taking to repair Ohio’s trust and it’s my hope they continue on this path of good faith.”
In addition, CC also had to pay a $55.5 million settlement to Mississippi for its alleged overpayments to state, according to the Mississippi attorney general press release.
Lynn Fitch, Mississippi’s attorney general, said she wanted to make sure Mississippians are not “being cheated by Centene or anyone else.”
“This settlement makes clear that the days of hiding behind a convoluted flow of money and numbers are over,” she said.
In these settlement agreements with Ohio and Mississippi, CC denied the allegations mentioned in these two state lawsuits, the CC press release says.
“We respect the deep and critically important relationships we have with our state partners,” said Brent Layton, Centene’s President of Health Plans, Markets and Products. “These agreements reflect the significance we place on addressing their concerns and our ongoing commitment to making the delivery of healthcare local, simple and transparent. Importantly, putting these issues behind us allows us to continue our relentless focus on delivering high-quality outcomes to our members.”
– – –