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Centene Settles Ohio, Miss. PBM Claims, Sets Aside $1.1B


June 14, 2021

Centene Corp. has agreed to pay Ohio $88.3 million and Mississippi $55 million to end claims that its pharmacy benefits manager, Envolve Pharmacy Solutions Inc., overbilled state agencies, while setting aside an additional $1.1 billion, the health care company announced Monday.

Centene said in a filing with the U.S. Securities and Exchange Commission that no-fault agreements with the attorneys general resolve an Ohio state court suit and allegations from the state of Mississippi related to “services provided by Envolve” and its “structure and processes” in 2017 and 2018.

The company also announced that it has recorded a reserve estimate of $1.1 billion “related to this issue.”

Ohio Attorney General Dave Yost sued Centene and its subsidiary Buckeye Health Plan in March, accusing its pharmacy benefit manager of overbilling the Ohio Department of Medicaid for drugs.

Yost said Monday that the deal is the first, and largest, secured by a state against a PBM.

“Centene used sophisticated moves to bill unearned dollars — moves known only at the top levels of health care companies,” Yost said in a release. “It has taken a huge effort by my team to untangle this scheme — and now that we know how it works, the alarm bells should be ringing for anyone using similar tactics.”

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Ohio is represented by Don W. Davis Jr. of Brennan Manna & Diamond LLC, David Nutt of David Nutt & Associates PC, W. Lawrence Deas and William Liston of Liston & Deas PLLC, and Steven J. Toll and Christina D. Saler of Cohen Milstein Sellers & Toll PLLC.

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