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‘No-fault’? Yeah, right. Centene’s foibles are starting to add up

The nation’s largest managed care organization (MCO) is settling yet another lawsuit for overbilling a state’s Medicaid’s program. Wouldn’t you know it, they’re not at fault in this one, either.

It’s been a while since we’ve done a good ‘ole update in our series, Managed Care Mischief. But not to worry — we’re back and headed to New Mexico, where Centene, known locally as “Centennial Care,” is ponying up $13.7 million to settle charges that it overbilled the state’s Medicaid prescription program.

*Brace yourselves.*

Centene is the largest Medicaid managed care organization (MCO) in the country. And in New Mexico, Centene ‘serves’ one million residents. But according to a June 15th article in Healthcare Dive, the health insurer isn’t actually serving the residents of New Mexico, but instead has been accused of “‘layering fees’ and not passing on retail discounts to the state Medicaid program.” And if it’s not going to the Medicaid program (where it’s supposed to), we can only guess where that extra cash is going: right back into the insurer’s pocketbook.

But don’t be fooled—Centene’s failings in New Mexico aren’t a one-time fluke in just one state. The insurer is garnering a reputation – to us, at least – for similar patters across the country. The same Healthcare Dive article reports that Centene paid more than $236 million in settlements in five additional states, including Ohio, Illinois, Arkansas, Mississippi, and New Hampshire, to quell similar overcharging allegations.

We’re starting to have déjà vu.

After writing about a half dozen of these, they sure seem to follow a similar pattern:

Step 1: A state investigates Centene and compiles substantial evidence around unnecessary and hidden fees, price transparency (or lack thereof), and overbilling.

Step 2: The company settles and accepts zero blame in “no-fault agreements.”

Step 3: The company then makes a statement about its commitment to “making the delivery of healthcare local, simple and transparent,” while turning around and paying out to the next state.

We have a few thoughts.

As you can tell by the series of state settlements, insurance is typically managed by the states.

So, we can’t help but wonder, is it time the United States takes a federal approach to regulating and actually enforcing these kinds of practices? Is it possible that these one-off, quick-hit, no-fault penalties aren’t really doing the deterrence they’re intended?

Now, it’s possible these are outdated practices and Centene is on the up and up. According to the Healthcare Dive, Centene doesn’t even want to be in the PBM game anymore.

But we’re skeptical. What’s that saying? ‘Fool me once, shame on you, fool me twice, shame on me.’ But … what about eight times?

Original Article:

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