Imagine this: Another PBM – multi million settlement because of OVER CHARGING state’s Medicaid ?

Centene Corp. reaches $13.7M settlement with New Mexico over pharmacy benefit practices

https://www.bizjournals.com/stlouis/news/2022/06/14/centene-million-settlement-new-mexico-pharmacy.html

New Mexico is the latest state where Centene Corp. (NYSE: CNC) has reached a settlement over an investigation into its pharmacy benefit management practices for the Medicaid program.

Attorney General Hector Balderas on Monday announced a $13.7 million settlement with Centene over the state’s investigation of its subsidiaries’ pricing and reporting of pharmacy benefits and services to New Mexico’s Medicaid program.

“Vulnerable New Mexicans should not have to worry about paying surging prescription drug costs,” Balderas said in a written statement. “This investigation was necessary to shine a light on industry practices, ensure greater accountability and return $13.7 million back to New Mexico.”

Centene did not make an executive available for comment Tuesday. A company spokesperson said in a written statement: “We respect the deep and critically important relationships we have with our state partners. 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. Importantly, this allows us to continue our relentless focus on delivering high-quality outcomes to our members.”

The pharmacy benefits management practices of Centene’s subsidiaries have triggered investigations in other states and a shareholder lawsuit against the largest public company in the St. Louis area.

Last December, Centene reached a $27.6 million settlement with the state of Kansas over its pharmacy benefit management practices for its Medicaid program.

Also last December, a shareholder filed a lawsuit against Centene in the Court of Chancery of the state of Delaware.

The plaintiff, Robert Garfield, has sought “books and records in order to determine whether breaches of fiduciary duty or other wrongdoing have occurred in connection with fraudulent business practices alleged in connection with civil settlements between Centene and state attorneys general in several states, including Ohio, Mississippi, Arkansas and Illinois.”

The Court of Chancery website listed the status of the lawsuit as active. An attorney representing Garfield didn’t return messages seeking comment.

In June 2021, Centene agreed to pay $88 million to Ohio’s Medicaid program to settle a lawsuit over how it charged the state for prescriptions. In a similar settlement that month, Centene reached a $55 million settlement with Mississippi.

Centene last September entered into no-fault agreements with the attorneys general of Arkansas and Illinois to resolve claims related to services provided by its pharmacy benefit manager subsidiary, Envolve Pharmacy Solutions Inc. Centene agreed to pay $15 million to Arkansas and $57 million to Illinois.

In a regulatory filing last year, Centene said it had set aside $1.1 billion to resolve allegations from other states. Two law firms — Liston & Deas and Cohen Milstein in Chicago — have entered into talks with Centene to resolve those matters. Attorney William Liston III and Centene did not respond to messages seeking comment on the status of settlement discussions.

The investigation of Centene by New Mexico’s attorney general focused on concerns that the corporation was “layering fees and not passing on retail discounts to New Mexico’s Medicaid program,” known as Centennial Care.

Centennial Care provides health care services and medications to nearly 1 million New Mexicans, and Centene’s wholly-owned subsidiaries have provided pharmacy benefits and services to Centennial Care since 2019.

The settlement agreement states that Centene’s entities will comply with New Mexico law governing the operation of managed care pharmacy benefit operations and an “enhanced commitment from Centene to provide complete pricing transparency on all pharmaceutical benefits and services” provided to the New Mexico Human Services Department.

Centene provides managed care programs for government sponsored health care plans such as Medicaid and Medicare.

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