Centene guilty of overcharging state Medicaid program, owes WA $19 million

[MM Curator Summary]: Planet Centene will pay out another 0.00019% of its revenue to WA state over PBM spread pricing allegations.



Attorney General Bob Ferguson and the Washington State Health Care Authority announced Centene, a publicly traded managed-care company, will pay $19 million to Washington state to resolve allegations of overcharging the state Medicaid program for pharmacy benefit management services.

The resolution is the second-largest Medicaid fraud recovery for Washington state in history. The amount goes back to the state through the state Medicaid Fraud Penalty Account.

As part of the resolution, an additional $13 million from Centene will be paid to the federal government for the administration of Medicaid in Washington state.

“Medicaid dollars are a precious resource meant to fund care for the most vulnerable among us,” Ferguson said. “My office works to ensure that these dollars go where they are intended — not toward fraud.”

Centene ranked No. 24 on 2021’s Fortune 500 list with its recorded revenue north of $100 billion, according to the Centene Corporation 2020 Annual Report.

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The Attorney General’s Office and Health Care Authority’s Program Integrity Team began investigating pharmacy benefit managers in 2019 after a whistleblower provided information that they were failing to disclose true pharmacy benefits and services costs.

Centene allegedly failed to pass on discounts it received to the state Medicaid program and inflated dispensing fees.

Earlier this week, Centene Corporation canceled its plans to build an east coast headquarters in Charlotte’s University City in what was originally considered the largest job announcement in Charlotte’s history. In July 2020, the company announced they were planning to create 6,000 new jobs once the headquarters were constructed, investing approximately $1 billion into the expansion.

Ferguson’s resolution with Wyeth is the only Medicaid fraud recovery larger than Centene. In 2016, Ferguson and the Attorney General’s Office recovered $46.7 million for the state Medicaid program, as the pharmaceutical company owed more than $780 million to states and the federal government for overcharging.

Centene has resolved cases with 10 other states over the same conduct.

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Clipped from: https://mynorthwest.com/3607059/centene-guilty-of-overcharging-state-medicaid-program-owes-wa-19-million/