HMN 2025: How Years later, Centene settlements with states are nonetheless unfinished

More than three years in the past, medical insurance large Centene Corp. settled allegations that it overcharged Medicaid applications in Ohio and Mississippi associated to prescription drug billing.

Now no less than 20 states have settled with Centene over its pharmacy profit supervisor operation that coordinated the drugs for Medicaid sufferers. Arizona was among the many most up-to-date to hitch the ranks, settling for an undisclosed payout, Richie Taylor, a spokesperson for the state’s legal professional common, instructed KFF Health News in December.

All instructed, Centene has agreed to pay greater than $1 billion in settlements, in keeping with Cohen Milstein, one of many legislation companies representing states within the agreements. Meanwhile, St. Louis-based Centene reported $163 billion in income in 2024, largely proceeds from authorities well being applications for Medicaid, Medicare, and the Affordable Care Act. The well being care firm has admitted no wrongdoing within the settlements.

Two state holdouts seem to stay: Georgia has but to settle with Centene, although the administration of Gov. Brian Kemp employed legislation agency Liston & Deas in 2019 to research state pharmacy profit operations.

Florida employed the identical legislation agency in 2021 to pursue overbilling allegations involving Centene, however state officers declined to reply a reporter’s questions on whether or not Florida has dropped the case, reached an undisclosed settlement, or continues to be discussing the difficulty.

Neither state has publicly disclosed what’s standing in the way in which of doubtless tens of thousands and thousands of {dollars} in Centene payouts, or whether or not negotiations are happening. Because the offers are largely occurring exterior the court docket system, the method between the non-public legislation companies employed by states and Centene stays usually out of public view.

Centene spokespeople didn’t return a number of cellphone calls and emails asking for updates. In 2022, the corporate stated it was engaged on settlements with Georgia and eight different states, having reached offers with 13 others. And in a Securities and Exchange Commission submitting in October, Centene stated it had reached settlements with “the overwhelming majority of states impacted” over the operations of its former pharmacy advantages supervisor.

Georgia has “taken disproportionately lengthy in comparison with different states,” stated Greg Reybold, a vp of the American Pharmacy Cooperative, which represents unbiased pharmacies.

Meanwhile, Centene’s Georgia Medicaid plan, the Peach State Health Plan, misplaced its bid final 12 months to proceed its longtime participation in a Georgia Medicaid program during which firms cowl the take care of Medicaid recipients for a set charge from the federal government somewhat than for every medical service supplied.

The firm, which has been a part of the contract because the managed-care program started in 2006, filed a protest over the contract awards, saying that the method was “mismanaged, rife with errors and reckless practices.”

Nationally, pharmacy profit managers, or PBMs, have come underneath elevated scrutiny over accusations of pocketing reductions on drugs or inflating prices within the years since Centene began settling its Medicaid-related allegations. Members of Congress have proposed main coverage constraints on PBMs. Centene has since overhauled its PBM operation.

Still, a potential settlement in Georgia might herald important cash to the state. California had the most important publicly disclosed settlement at $215 million, break up with the federal authorities, however a settlement with Georgia could possibly be within the vary of the $88 million that Centene agreed to pay within the Ohio dispute, Reybold stated.

The state ought to aggressively pursue a settlement with Centene, stated Roland Behm, co-founder of the Georgia Mental Health Policy Partnership, who’s a critic of Centene and its Georgia Medicaid plan. Behm stated state Attorney General Chris Carr ought to take “the identical tenacious prosecutorial motion” in opposition to Centene that Carr’s company takes in opposition to people concerned in fraud in opposition to Medicaid, the federal-state program that gives medical insurance protection for these with low incomes or disabilities.

Carr’s workplace stated in 2022 that it stood able to symbolize Georgia in settlement negotiations with Centene. Carr, a Republican who has introduced he is working for governor in 2026, obtained tens of 1000’s of {dollars} in marketing campaign contributions from Centene, its subsidiaries, and its executives, as did Kemp, a fellow Republican, KFF Health News reported in 2022.

Contributions to the Kemp and Carr campaigns had been a part of greater than $26.9 million that Centene, its subsidiaries, its prime executives, and their spouses donated to state politicians in 33 states, to their political events, and to nonprofit fundraising teams from 2015 by way of 2022.

Since 2022, the corporate and its political motion committee have contributed, mixed, no less than $2 million extra to the campaigns of Florida and Georgia candidates of each political events, together with state get together organizations and political committees, in keeping with state marketing campaign finance information.

When requested a couple of potential settlement, a spokesperson for Carr, Kara Murray, directed a reporter to the Georgia Department of Community Health, which administers Medicaid.

Fiona Roberts, a spokesperson for that company, then instructed KFF Health News that the division “is actively pursuing choices to make sure regulatory compliance with the state’s contract.” She declined to remark additional.

Florida’s legal professional common’s workplace directed a reporter to the state company that oversees Medicaid, the Florida Agency for Health Care Administration. But that company didn’t reply to a number of cellphone calls and emails requesting remark.

2025 KFF Health News. Distributed by Tribune Content Agency, LLC.