Skip to Content

Ohio to Centene: I want my millions back!

On March 11, Modern Healthcare covered a lawsuit alleging that the insurance giant purposefully overcharged the state Medicaid program for pharmacy benefits.

Well, here we are again. Yet another group is calling in counsel—and calling out insurers—on their shady practices related to pharmacy benefit managers (PBMs). This time, it’s Ohio’s attorney general Dave Yost, who is suing insurance company Centene for what he’s called a “conspiracy” to deceptively jack up prices to get higher Medicaid payments.

The background: Ohio’s Department of Medicaid uses a Centene subsidiary called Envolve Health Solutions to manage state benefits for almost 3 million lower-income adults and children on Medicaid. The suit says that Envolve double-billed the state by hiring subcontractors—its own PBMs—to administer prescription drug benefits. Yost contends that the insurer did this to misrepresent pharmacy costs, having already hired another contractor to do the same job. The result, the suit claims, was that Ohio gave Centene millions in overpayments.

For its part, Centene claims that Ohio reviewed the contract before it went into effect, and states that Envolve will be aggressively defending its actions.

Sadly, this isn’t the only recent incident where insurers seem to be engaging in questionable PBM practices. And given the unsavory practice’s potential for massive profit, we doubt that it will be the last.

Original Article:

Subscribe to Un-covered Essentials

Insurer policies limit coverage and disrupt patient care, while producing record profits for corporate shareholders. Stay informed with the Un-covered newsletter.