Centene settles with Texas conduct first detected in Ohio

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Texas has become at least the 12th state to settle potential allegations that healthcare giant Centene defrauded that state’s Medicaid program, state Attorney General Ken Paxton announced earlier this week.

The deal will pay the Lone Star State $166 million to release it from claims similar to those first alleged in Ohio in March 2021.

Centene, the nation’s largest Medicaid managed care contractor, provides such services in Ohio and Texas under the names Buckeye Health Plan and Superior HealthPlan, respectively.

In the Ohio lawsuit, Attorney General Dave Yost accused Centene’s Buckeye of using its pharmacy intermediaries to overcharge taxpayers millions for prescription drugs.

That investigation followed a 2018 report by The Columbus Dispatch showing that a year earlier Buckeye had billed the state $20 million for services provided through his drug intermediary. But those same services appeared to have been rendered by a separate company – CVS – who was also paid, according to the story. Centene and Buckeye both denied that they were duplicating themselves.

In its agreements with Ohio and Texas, Centene emphasized that it does not admit wrongdoing and continues to do business in both states.

In a statement, Paxton said the Texas settlement shows his office is serious about stopping fraud.

“Protecting taxpayer funds and the financial integrity of the Texas Medicaid program is a top priority for my office,” he said. “The results we obtained in this case send a clear message to providers that Texas expects transparency from its Medicaid partners, as required by Texas law.”

An anti-fraud message from Texas AG may seem ironic because Paxton has been under indictment for the crime of securities fraud since 2015. Like Centene in his settlement with Texas, Paxton denies any wrongdoing in his criminal case.

When announcing the settlement here, Ohio AG Yost said that as part of the deal, Centene agreed to pay Ohio at least as much as every other state.

Texas’ settlement with Centene is twice the $88 million it paid Ohio. But it’s unclear if that means Ohio will get more money.

This is because the promise seems to be on a per subscriber basis or something similar. The Ohio settlement says, “The Centene Entities will not enter into any other settlement agreement with any other state regarding conduct that is the same or similar to the conduct alleged in the Ohio action that contains a more recoupment calculation methodology. favorable than that contained in the settlement agreement. and release.

The Superior Healthplan website states that it has 1.7 million registered in Texas, while Buckeye’s says that 300,000 Residents of Ohio use his services to obtain benefits from Medicaid, Medicare, or through insurance marketplaces. So, if the relative number of Medicaid enrollees is at the base of the Centene colonies, Ohio’s is much larger than that reported by Texas.

When Centene announced settlements with Ohio and Mississippi last year, it said it was setting aside $1.1 billion to settle those claims with more than 20 states.

Kaiser Health News this week reported that in addition to Ohio, Mississippi and Texas, Arkansas, Illinois, Kansas, New Hampshire, New Mexico and Washington are known to have settled so far. California, Florida and South Carolina may be negotiating settlements, the news agency reported.

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