In case you’re not up to speed on the drama, managed care organization Centene is no stranger to legal settlements. We call it ‘managed care mischief’ — when a private company is accused of misusing state dollars and failing to actually, you know, manage the care appropriately for Medicaid enrollees.
Centene is the largest MCO in the country and they get into legal trouble…a lot. Methods such as unnecessary hidden fees, a lack of price transparency, and overbilling are just some of the ways that Centene has been accused of mismanaging care. (All things you’d want your insurance company to do, right?)
To name a few of their alleged wrong doings:
- In New Mexico, for instance, Centene was accused of ‘layering fees’ and overbilling the state’s Medicaid prescription program, pocketing the cash. As a result, the MCO had to pay $13.7 million in settlements.
- In Kansas, Centene paid $27.6 million to the state after an investigation into its sketchy pharmacy benefit manager (PBM) services.
- Don’t forget about Ohio, where a Centene subsidiary was accused of double-billed the state by hiring subcontractors — its own PBMs — to administer prescription drug benefits.
- And in Arkansas and Illinois, Centene settled claims of overcharging Medicaid programs and failing to accurately disclose discounts and dispensing fees, settling for a cool $72 million.
And to add more recent accounts to the list:
- In Texas, Centene is paying the state $166 million for overcharging Medicaid prescription drug programs.
- In Massachusetts, the insurance giant owes $14 million in settlements for overbilling the state’s Medicaid program for pharmacy services.
- In Oregon, Centene has agreed to pay $17 million to settle an investigation on overcharging the state’s Medicaid program.
- In Iowa, Centene reached a $44 million settlement with the state for…you guessed it… overcharging pharmacy services.
It seems even with millions in settlements, the Centene bank account is doing just fine. And next year, Centene expects to rake in revenue between $137.4 billion and $139.4 billion, Fierce Healthcare reports. Cool, cool.
“We look forward to sharing more about Centene’s long-term strategy and our plan to deliver profitable growth and increasing value to shareholders into the future during our investor day,” shared Sarah London, CEO of Centene, in a December press release.
We bet you do.
While full earnings haven’t yet been released, we’ll have to wait until later in February to get the full figures, but what we do know means the company expects their profits to keep rising. Nevertheless, it seems like managing Medicaid plans is good business…even if it runs you into a couple lawsuits here and there for allegedly overcharging the states who hire you.
The business is so good, the company is “pleased” to announce its latest state contract in sunny California.
All we can say is, given Centene’s clear record of questionable behavior…watch out, California.
