Attorney General Dave Yost announces that Ohio sued healthcare giant Centene Corp. for an extensive plan to maximize company profits at the cost of the Ohio Department of Medicaid (ODM) and the state of Ohio. The lawsuit testifies that Centene subsidiary Buckeye Health Plan utilized a web of subcontractors to provide pharmacy benefits to mislead pharmacy costs, appearing in millions of dollars of overcharges by ODM. “Corporate greed has led Centene and its wholly-owned subsidiaries to fleece taxpayers out of millions.
This conspiracy to obtain Medicaid payments through deceptive means stops now,” Attorney General Yost said. “My office has worked tirelessly to untangle this complex scheme, and we are confident that Centene and its affiliates have materially breached their obligations both to the Department of Medicaid and the state of Ohio,” he added. About 2.9 million Ohioans received a medical assistance plan coverage by The Department of Medicaid administers, and it does so within the use of Managed Care Organizations (MCOs). One such MCO, Centene’s Buckeye Health Plan, manages its pharmacy advantage via sister companies Envolve Health Solutions and Health Net Pharmacy Solutions. The usage of subcontracting to more than one Pharmacy Benefit Manager (PBM) raised questions about Buckeye Health Plan’s business practices and, ultimately, Centene’s.
Based on the research, Attorney General investigated these practices, finding significant breaches of contract. Notably, these include
- They are filing reimbursement requests for amounts already paid by third parties.
- Failing to accurately disclose the actual cost of pharmacy services to ODM, including the disclosure of discounts received.
- They were artificially inflating dispensing fees.
According to Attorney General Yost, Centene’s actions are sincerely concerning and directly impact the most vulnerable Ohioans, he also stated that Centene had destroyed trust with the state of Ohio, and I intend to hold this company accountable for its deceptive practices. The lawsuit filed by the Franklin County Court of Common Pleas is a message to corporations nationwide that Ohio will not allow them to profit at the expense of our taxpayers impermissibly. A lawsuit under seal due to confidentiality with nondisclosure agreement on March 11th in the Franklin County Court of Common Pleas. Ohio has had it with Centene’s alleged “corporate greed.” The state filed a lawsuit about the St. Louis-based company.
Involved in an intricate conspiracy to maximize profits at the expense of its Medicaid department. However, Centene continues to deny their wrongdoings, stating that the claims are “unfounded.” The lawsuit appears numerous years after a Columbus Dispatch investigation describing how Centene’s Buckeye Health Plan contracted with Envolve Health Solutions and Health Net Pharmacy Solutions to administer pharmacy benefits. However, it has already hired CVS Caremark to accomplish these same benefits. On another side, Buckeye was double-billing the state by using two separate sets of pharmacy benefit managers. According to a 2019 explainer by Commonwealth Fund, the Pharmacy benefit managers administer prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large companies, and other insurers. They act as brokers, and their role in the drug delivery chain has faced heightened investigation in recent years.
It is enormous because pharmacy benefit managers usually receive discounts calculated as a percentage of the manufacturer’s list price, meaning they get a higher deduction for more expensive drugs. In this case, misgivings because Buckeye charged nearly double for prescription drugs compared with other managed care organizations hired by the state to coordinate Medicaid services. The attorney general’s office, through outside counsel, investigated Centene and Buckeye and found evidence of several contract violations.
These involve arranging reimbursement requests for products already paid by third parties, leaving to disclose the actual value of pharmacy services accurately, and artificially increasing dispensing fees.
