Centene Corporation, once again, showed that they have no plans on taking accountability for their faults.
After entering into settlement agreements with Kansas, Mississippi, Illinois, and Arkansas worth over $ 181 M, Centene is charged with pharmacy benefit management fraud–this time, in the State of New Hampshire. In line with this new issue in New Hampshire, the Department of Human Health Services (DHHS) and the Department of Justice (DOJ) conducted an extensive investigation and compliance review of Centene’s provision of pharmacy benefits in New Hampshire’s Medicaid Care Management Program.
The said corporation is set to pay a total of $ 21,148,822.13 in settlement fees to the State of New Hampshire, Attorney General John M. Formella confirmed.
Probing Centene once again
The DHHS and the DOJ began this investigation and review on Centene’s pharmacy benefit services as other states had publicly announced probes on pharmacy benefit management fraud. These departments looked into Centene’s reports on the costs of its pharmacy benefit services in New Hampshire’s Medicaid program. Based on the probe in New Hampshire, Centene was proven to have overcharged their pharmacy benefit claims again. The questionable reporting of claims in the said program begs the question of whether or not Centene really prioritizes the welfare of its stakeholders.
The findings of the DHHS and the DOJ showed that the inconsistencies in the pharmacy benefit services of Centene led the State to accumulate at least $2.4 M worth of losses during the settlement period. This amount, which is a huge loss for the state, could have been used for other social services that promote the welfare of New Hampshire’s citizens instead of going into Centene’s pockets.
The State of New Hampshire accepted the settlement fee, but it was only accepted on the assumption that Centene would ensure full transparency as they continue to provide services.
What Happens Next to Centene
Based on the agreement, the settlement period is from January 1, 2016 through December 30, 2021. The settlement states that Centene needs to pay their dues, which would be divided into two equal annual installments. Centene’s first payment has to be settled within 45 days at the onset of the agreement. Then, the other half of the fees would have to be paid within a year after the first payment. This computation is based on an existing formula that Centene also used in other settlement cases nationwide.
Centene’s actions prove that not all insurance providers put their stakeholders first in terms of providing services. Although key officials of the DHHS and the DOJ are convinced that the resolution was reasonable, they reiterated that they will keep on conducting compliance reviews on the Medicaid Care Management Program, and this would include the two other Medicaid Care Management health plans in the State of New Hampshire. Compliance reviews should be more rigorous and timely so that other insurance providers would not be confident that they can pull off fraud the way Centene did.
