After having struck a deal with at least five states now, Centene stands firm on admitting no liability.
In a news release, Kansas Attorney General Derek Schmidt revealed that Centene had negotiated a $27.6 million settlement with the state on allegations of overcharging with pharmacy benefit management (PBM).
Following Mississippi, Illinois, and Arkansas disclosed $154 million in settlements, Kansas struck a $27.6M agreement. All this comes after the company accepted an $88.3 million deal with Ohio Attorney General Dave Yost, the only state to pursue the renowned fraud, Centene.
It was earlier noted in the claims made by the states of Ohio and Mississippi against Centene’s pharmacy benefits manager subsidiary, Envolve Pharmacy Solutions Inc., that the corporation was allocating $1.1 billion to address prospective settlements in 22 other states. Undeniably, there was no guarantee that the company would settle the claims within the agreed-upon reserve estimate.
Envolve was responsible for paying pharmacies, creating a prescription formulary, and negotiating with pharmaceutical firms for rebates. In accordance with Arkansas Attorney General Leslie Rutledge, the company overcharged Medicaid far more than stipulated limitations for medications. At the same time, Illinois revealed that Envolve allegedly neglected to disclose applicable discounts and increased dispensing rates inappropriately.
On the word of Kansas Attorney General Derek Schmidt, Centene neglected to “satisfy its obligation to represent the state’s best interests” in managing prescription pricing in Medicaid.
Centene ‘Under the Microscope’
Ever since a similar probe in Ohio discovered pharmacy benefit managers were overbilling states, Kansas launched its own investigation against Centene in 2019. The state’s investigation revealed that Centene illegally increased dispensing charge amounts submitted to state regulators and withheld to declare discounts it obtained from CVS-Caremark on some retail pharmacy claims.
As per the Attorney General, Centene participated in a series of schemes that resulted in Kansas taxpayers overpaying for prescription medicines. It might, for one, charge Kansas one price for a drug while negotiating a lower price with the manufacturer. Centene, in turn, then collect the profits by concealing the exact cost from Kansas.
Attorney General Schmidt emphasized that his office takes seriously the obligation of protecting Kansas taxpayers by finding and preventing fraud and overpayments in the state Medicaid program.
However, despite the Kansas Attorney General’s repeated attempts to pursue Centene, the company persisted in keeping the case out of a trial.
As part of the settlement, Centene pledged to improve transparency by granting Kansas access to data needed to establish the nature and propriety of pharmacy transactions. Despite this, the settlement was dubbed a “no-fault agreement.”
“This no-fault agreement reflects the significance we place on addressing their concerns”, Schmidt added, referring to their state partners.
Centene focuses on supporting the management of Kansas’ Medicaid program but will have to contend for that position when the Kansas Department of Health and Environment launches a new round of bidding in the near future.
“Regardless of whether there’s an explicit admission, they’re paying millions of dollars for their past behavior and agreeing that their future behavior will change,” the Attorney General declared.
