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Seven Things To Know When You Receive A Notice Of Investigation From The Department Of Health

Centene Pays California $215 Million in Alleged Medicaid Overbilling Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 8, 2023, Centene Corp. agreed to pay more than $215 million to the state of California over allegations that Centene overcharged the state for pharmacy services. It is the biggest payout to date by the nation’s largest Medicaid insurer over its drug pricing practices. Centene has contracts with the state of Florida allegedly reportedly exceeding $3 billion.  In Florida, Centene now owns and operates Sunshine State Health Plan.

The Missouri-based company, the country’s largest provider of Medicaid insurance plans, agreed to deal, roughly half of which will be paid to the Medi-Cal Program in restitution, without admitting liability. Additionally, in doing so, it resolved the California Attorney General’s claims against it under the False Claims Act (FCA).

Inflated Drug Costs and Fees.

Investigators with the state Department of Justice (DOJ) found that Centene’s subsidiaries reported inflated drug costs and fees in providing prescription drugs to patients in Medi-Cal from January 2017 to December 2018. Medi-Cal is the state’s Medicaid insurance program for people with low incomes and disabilities.

The state investigators allege that over the two years, Centene leveraged certain advantages in its pharmacy benefit manager contracts to save its plans $2.70 per prescription. But, despite saving millions of dollars annually on prescription discounts, Centene and its pharmacy benefit manager have yet to report its savings to Medi-Cal or the state, according to the DOJ.

As it has in previous settlements, Centene has denied any wrongdoing. However, a Centene spokesperson said that the company respects its “deep and critically important” relationships with state health care programs. “This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making healthcare delivery local, simple and transparent,” the statement says.

Click here to view the settlement in full.

In recent years, Centene has faced a legal reckoning over its Medicaid billing practices. More than 20 states are investigating or have investigated Centene’s Medicaid pharmacy billing.  Click here to read my prior blog and learn more.

Contact Health Law Attorneys Experienced with Medicare and Medicaid Fraud, False Claims Act Violations and Whistleblower Lawsuits.

The attorneys of The Health Law Firm represent health professionals and providers in cases audits by and payment disputes with MedicareMedicaid, Tricare, health insurers and managed care organizations.  They have experience in representing healthcare providers who are involved in audits by Centene and Sunshine State Health Plan.  Even after an audit they can assist you in appealing the results of the audit and in disputing any overpayment demand made.  Our attorneys routinely represent psychoanalysts, behavioral therapists, home health care companies, professional counselors, social workers, certified behavior analysts, physicianspharmaciespharmacists and other healthcare providers in defending investigations, audits, recovery actions and termination from the Medicare or Medicaid Programs.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at


Atkins, Dorothy. “Centene Cuts $215M False Claims Act Deal With Calif. AG.” Law360. (Februrary 8, 2023). Web.

Young, Samantha. “Centene agrees to pay $215M settlement to California in alleged Medicaid overbilling.” Modern Healthcare. (February 9, 2023). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620

Attorney Positions with The Health Law Firm.  The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

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