Centene Reaches $ 72 Million Settlement With Illinois, Arkansas Over Alleged Medicaid Overbills


UPDATE: October 1, 2021: Centene said in a statement, “We respect the deep and critically important relationships we have with our state partners. These flawless agreements reflect the importance we place on responding to their concerns and our continued commitment to making peace. simple and transparent local health care delivery. “

Dive brief:

  • The Arkansas and Illinois attorneys general announced Thursday that they both reached multi-million dollar settlements with Centene after the insurer overcharged their respective Medicaid programs for the prescriptions.
  • The alleged overruns occurred after Centene’s subsidiary, Envolve Pharmacy Solutions, failed to disclose the relevant discounts, Arkansas Attorney General Leslie Rutledge says. Centene also unduly inflated the execution fees, Illinois Attorney General Kwame Raoul alleged.
  • Centene will pay Illinois a total of $ 56.7 million in two installments over the next 12 months and $ 15.2 million to Arkansas under a similar deal.

Dive overview:

The latest settlements come just months after Centene struck similar deals in Ohio and Mississippi, in which the St. Louis-based insurer agreed to pay a total of $ 143 million to resolve overcharging allegations drugs to both states.

The state of Ohio dropped its lawsuit against Centene following the settlement. The payer did not admit the fault in the regulations, but at the time the company set aside $ 1.1 billion to settle future disputes in other states, according to an earlier file with the United States Securities and Exchange Commission.

In a series of tweets On Thursday, Rutledge explained that Centene’s Envolve was responsible for managing the state’s prescription drug program and had been hired to reimburse pharmacies, create lists of preferred drugs and negotiate discounts with other drug companies.

“When Envolve billed Arkansas Medicaid for the drugs, the contracts required costs to be capped by certain industry standard prices, but Envolve billed Arkansas Medicaid more than the allowable price cap,” tweeted Rutledge.

Centene did not immediately respond to a request for comment.

Pharmacy benefit managers have come under fire in recent years for their opaque modus operandi and their role in driving up drug costs. The poorly transparent business model of PBMs has already sparked scrutiny lawmakers interested in tackling drug price reform.

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