Centene might not be one of the Big Five health insurers, but it sure knows how to “follow the leader” when it comes to sneaky business. Oh, and did we forget to mention that Centene is a $111 billion corporation?
According to an article in The Columbus Dispatch, Ohio currently uses private insurance companies to handle its $3 billion Medicaid program, which provides healthcare coverage for people with disabilities or low incomes. It’s a much-needed program, too. Per the article, more than one in four Ohioans currently receives Medicaid benefits, including nearly 1.3 million children.
Centene was recently added to Ohio’s list of carriers to manage these plans, among some of our regular cast of characters: UnitedHealthcare, Humana, Anthem, and more. This all seems normal and provides another option for Ohio’s Medicaid beneficiaries. What’s the catch? Long story short: Centene almost didn’t make the cut. The Ohio Attorney General Dave Yost sued Centene and its related entities, stating that the companies defrauded Ohioans of millions. (Yup, that’ll do it.)
Yost sued, alleging Centene used $20 million in taxpayer money to hire a pharmacy benefits manager (PBM) to provide services for Medicaid recipients that were already covered by another PBM paid by the state. Centene was also charging the state more than twice the per-prescription costs of the other four, a state consultant told the Dispatch.
For Centene’s part, the company vehemently denies these claims, stating that the allegations are unfounded. Centene also claims that their services “saved millions of taxpayer dollars for Ohioans from market-based pharmaceutical pricing.” But then, Centene agreed to a $88 million settlement with the state in June; the insurer also set aside more than $1.1 billion to resolve claims with other states.
Has Centene been crossing their fingers behind their backs this whole time? They sure seem to see a benefit to settling with states. Could it be the Medicaid money on the line?
And as for Ohio, Yost and his regulators took a firm stand. But are they certain Centene’s learned their lesson? We sure aren’t.