Centene Reaches $166 Million Settlement With Texas Over Its Medicaid Drug Pricing
Tuesday, November 8, 2022
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
The nation's largest Medicaid insurer, Centene, has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. The deal was signed July 11, 2022 but hadn’t been publicly announced until September 19, 2022. The agreement makes Texas at least the 12th state to settle pharmacy billing claims with St. Louis-based Centene. It’s also the biggest known payout by the health insurance giant over its drug pricing practices.
The Allegations Across Many States.
The allegations focused on Centene’s pharmacy benefit manager business, claiming that it overbilled the state’s Medicaid programs for prescription drugs and pharmacy services. Such benefit managers act as middlemen between drugmakers and health insurers and as intermediaries between health plans and pharmacies. Multiple states have pursued allegations against Centene’s pharmacy manager business, alleging that it overbilled their Medicaid programs for prescription drugs and pharmacy services.
So far, Centene has settled with Arkansas, Illinois, Kansas, Mississippi, New Hampshire, New Mexico, Ohio, Texas, and Washington for a total of $475 million, according to news releases and settlement documents. Three other states and their settlement amounts have not been identified by Centene or the states themselves. Exactly how the company may have overcharged states, or failed to meet the terms of its contracts, is not disclosed. To learn more, click here to read one of my prior blogs on Centene.
Click here to view the settlement in full.
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 Medicare, Medicaid, 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, physicians, pharmacies, pharmacists and other healthcare providers in defending investigations, audits, recovery actions and termination from the Medicare or Medicaid Programs.
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Health Law Section. "Nation’s Largest Medicaid Insurer to Pay $166 Million to Texas in Drug Pricing Settlement." American Bar Association. (September 30, 2022). Web.
Miller, Andy. "Centene to Pay $166 Million to Texas in Medicaid Drug Pricing Settlement." Kaiser Health News. (September 20, 2022). 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. www.TheHealthLawFirm.com 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: PAlexander@TheHealthLawFirm.com or fax to: (407) 331-3030.
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