To resolve two contested overpayment charges, Centene agreed to pay $72 million to Arkansas and Illinois.
After amassing a settlement streak throughout the year, Centene reached its third and fourth agreements with states, Illinois, and Arkansas over purported overcharging claims of state Medicaid programs for prescription drugs.
Earlier this year, the company struck deals with Ohio and Mississippi for $88 million and $55 million, respectively, over the same complaints.
Centene, as is customary, denied liability in both cases stated. Centene, then again, is out of options now that both settlements have been issued. Attorney General Kwame Raoul of Illinois announced a $56.7 million settlement for his state, which would be paid out in two installments over the next year, while Arkansas Attorney General Leslie Rutledge confirmed a $15.2 million resolution.
The initial cases arose from charges that Centene’s pharmacy benefit manager (PBM) affiliate, Envolve, has been overpaid by Medicaid programs of the state.
Centene subsidiary Envolve and other companies offered pharmacy coverage to Illinois state agencies being a PBM for Illinois’ Medicaid program, as did Arkansas state agencies. These benefits, however, took a somewhat disastrous turn.
Centene’s Fraudulent Pattern Uncovered
In light of the investigation conducted by the Illinois Attorney General’s office, it was revealed that Centene allegedly provided fraudulent pharmaceutical reimbursement forms, failing to fully disclose the expense of pharmacy services.
Furthermore, reimbursement claims failed to mention potential pharmaceutical discounts and overly inflated dispensing charges.
Centene claimed in a statement that “this no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making the delivery of healthcare local, simple, and transparent.”
However, Illinois Attorney General Kwame Raoul, firmly believes that pharmacy benefit managers (PBMs) are a contributing factor to a far greater issue, owing to the accessibility and affordability of prescriptions, and its lack thereof.
“No one should choose between paying for basic necessities or costly but essential medicines”, Raoul attested.
In the similar case of Arkansas, Envolve subcontracted the handling of payments to pharmacies to CVS Caremark after the state’s Medicaid officials sought assistance in managing its prescription drug program. And as such, the company neglected to disclose the discounts and dispensing fees acquired as part of the contract.
As per the state, the misconduct transpired back in 2017 and 2018 and ended with Envolve and CVS terminating their partnership.
Centene has pledged to provide total transparency in the adjudication and settlement of all pharmacy benefit disputes in Arkansas in the future, along with the actual amount charged to the pharmacy for every pharmaceutical complaint.
“I have successfully fought predatory pharmacy benefit managers in the nation’s highest court, and I continue to hold these providers accountable for gouging Arkansans with unreasonably high costs for their prescriptions,” Rutledge remarked.
As the case concluded, Attorney General Rutledge vowed to continue aggressively pursuing PBMs accountable for overcharging consumers and slashed prescription reimbursements granted to local pharmacies, in an effort to uphold and safeguard Arkansas consumers.
