More than three years ago, the health insurance giant Centene Corp. Settled allegations according to which he has surfed Medicaid programs in Ohio and Mississippi linked to the invoicing of prescription drugs.
At least 20 states have settled with Centene about its pharmacy benefits management operation which coordinated medication for Medicaid patients. Arizona was among the most recent to join the ranks, contenting itself with an uncompromising payment, Richie Taylor, spokesperson for the State Prosecutor General, told Kff Health News in December.
All in all, Centene has agreed to pay more than a billion dollars in regulations, according to Cohen MilsteinOne of the law firms representing states in the agreements. Meanwhile, Centene, based in St. Louis, declared $ 163 billion in revenues in 2024, occurs largely of government health programs for Medicaid, Medicare and the affordable care law. The health care society has not admitted any reprehensible act in the colonies.
Two state holples seem to remain: Georgia has not yet settled with Centene, even if the administration of Governor Brian Kemp Cabinet of lawyers hired Liston & Deas In 2019 to investigate state -based pharmacy services.
Florida hired the same law firm in 2021 to pursue excessive allegations involving Centene, but state officials refused to answer a journalist’s questions on the question of whether Florida abandoned the case, concluded a non -disclosed or discussed regulation.
None of the two states has publicly revealed what is potentially tens of millions of dollars in hundreds, or if negotiations take place. Because transactions are largely occurring outside the justice systemThe process between private law firms hired by states and Centene generally remains outside the public.
Centene spokesperson have not returned several telephone and email calls requesting updates. In 2022, the company said it worked on the colonies With Georgia and eight other states, having concluded agreements with 13 others. And in a securities and exchange commission Deposit in OctoberCentene said he had reached colonies with “the vast majority of states had an impact on the operations of his former benefits in pharmacy benefits.
Georgia has “taken disproportionately compared to other states,” said Greg Reybold, vice-president of the American Pharmacy Cooperativewhich represents independent pharmacies.
Meanwhile, the plan of Georgia Medicaid of Centene, the health plan of Peach State, lost its offer last year to continue its longtime participation in a program of Georgia Medicaid in which Companies cover care For the beneficiaries of Medicaid for a fixed government law rather than for each medical service provided. The company, which has been part of the contract since the start of the care program managed in 2006, filed a demonstration During the contract prices, saying that the process was “poorly managed, filled with errors and reckless practices”.
At the national level, the managers of pharmacy services, or PBM, have is increased failure On accusations of discount on medication or inflation costs in the years that followed Centene began to settle its allegations linked to Medicaid. The members of the Congress proposed major policy constraints on PBM. Centene has since revised her PBM operation.
However, a possible regulation in Georgia could provide large funds to the state. California had the The largest public disclosed colony At $ 215 million, separated with the federal government, but a regulation with Georgia could be in the range of $ 88 million that Centene agreed to pay in the Ohio dispute, said Reybold.
The state should aggressively continue a settlement with Centene, said Roland Behm, co-founder of the Mental health policy partnership in GeorgiaWho is a critic of Centene and his plan Georgia Medicaid. Behm said that the prosecutor General Chris Carr should take “the same tenacious action” against Centene that the Carr agency takes against the people involved in fraud against Medicaid, the Federal State Program which offers health insurance coverage for low -income or disability.
The Carr’s office said in 2022 that he was ready to represent Georgia in the settlement with Centene. Carr, a Republican who announced that he was presented to the post of governor in 2026, received tens of thousands of dollars in contributions to the Centene campaign, his subsidiaries and his leaders, just like Kemp, a republican colleague, Kff Health News reported in 2022. Contributions to the Kemp and Carr campaigns were part of more than $ 26.9 million than Centene, its subsidiaries, its main leaders and their spouses have donated to state politicians in 33 states, their political parties and non -profit collection groups from 2015 to 2022.
Since 2022, the company and its political action committee have contributed, combined, at least $ 2 million more to the Florida and Georgia campaigns to the two political parties, as well as state organizations and political committees, according to the state funding registers.
Asked about a possible regulation, a carr spokesperson Kara Murray, led a journalist at the Georgia Department of Community Health, who administers Medicaid.
Fiona Roberts, spokesperson for this agency, then told Kff Health News that the ministry “actively pursues options to guarantee regulatory compliance with the State contract”. She refused to comment more.
The Florida Prosecutor General’s office led a journalist to the state agency who supervises Medicaid, the Florida agency for the administration of health care. But this agency did not respond to several phone calls and emails asking for comments.
Rebecca Grapevin from Healthbeat contributed to this article.
