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Centene Settles Ohio Suit Alleging Medicaid Fraud for $88M

Associated Press

June 14, 2021

Centene Corp. has agreed to pay Ohio $88.3 million to settle a lawsuit alleging the pharmacy benefit manager overbilled the state’s Medicaid department for pharmacy services it provided, the state’s top lawyer announced Monday.

Republican Attorney General Dave Yost said the settlement is the first and largest in the nation secured by a state attorney general against a pharmacy benefit manager. PBMs are third-party companies that manage health care plans, including Medicaid, which serves 2.9 million Ohioans.

Yost’s suit alleged Centene and its subsidiary, Buckeye Health Plan, conspired to misrepresent the costs of pharmacy services it provided Ohio, which included the prices of prescription drugs.

The attorney general said state investigators uncovered a sophisticated scheme to bill unearned dollars known only at the top levels of health care companies. Yost alleges a series of contract breaches, including double-billing, failing to disclose drug discounts that affected prescription costs and artificially inflating fees.

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Talks continue with a plaintiffs’ group “in an effort to bring final resolution to these concerns in other affected states,” the company said.

Read Centene Settles Ohio Suit Alleging Medicaid Fraud for $88M.