Massachusetts has become the latest state to settle with health insurance giant Centene Corp. over allegations that it overbilled the state\u2019s Medicaid program for pharmacy services, KHN has learned.<\/p>\n

Centene, the nation\u2019s largest Medicaid managed-care insurer, will pay $14.2 million, according to Massachusetts Attorney General Maura Healey. An official announcement is expected later Thursday.<\/p>\n

\u201cThis settlement is a significant result in our work to protect taxpayer dollars and the integrity of our MassHealth program,\u201d Healey said in a statement.\u00a0\u201cWe are pleased to secure these funds to help control Medicaid costs and ensure that state resources are directed to the best possible uses in our health care system.\u201d<\/p>\n

Centene on Wednesday denied wrongdoing in Massachusetts, as it has in previously announced settlements. KHN reported earlier this month that Centene agreed in July to pay Texas<\/a> nearly $166 million.<\/p>\n

\u201cThis 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,\u201d Centene said in a statement emailed to KHN. \u201cImportantly, this allows us to continue our relentless focus on delivering high-quality outcomes to our members.\u201d<\/p>\n

Centene provides health insurance to 15.4 million Medicaid enrollees across the country by contracting with states to cover people who have disabilities or are in low-income families. The St. Louis-based insurer earns about two-thirds of its revenue from Medicaid, which is jointly funded by state and federal taxpayers.<\/p>\n

In many states, insurance companies such as Centene also administer Medicaid enrollees\u2019 prescription medications through what is called a pharmacy benefit manager. These benefit managers act as middlemen<\/a> between drugmakers and health insurers and as intermediaries between health plans and pharmacies.<\/p>\n

Centene\u2019s CeltiCare subsidiary offered insurance to Massachusetts Medicaid enrollees until the state began to overhaul its program. Centene also administered pharmacy benefits for the state Medicaid program, MassHealth, according to the attorney general\u2019s office.<\/p>\n

A review by Healey\u2019s office found \u201cirregularities in the pricing and reporting of pharmacy benefits and services\u201d by Centene\u2019s pharmacy benefits manager, Envolve Pharmacy Solutions, its statement said.<\/p>\n

Multiple states have settled with Centene\u2019s pharmacy manager business over allegations that it overbilled their Medicaid programs for prescription drugs and pharmacy services. But the total number of states is not publicly known because many of the settlement negotiations are conducted behind closed doors. Some states, such as California, have been investigating the company, KHN first reported in April<\/a>.<\/p>\n

Before the Massachusetts agreement, Centene had settled with Arkansas, Illinois, Kansas, Mississippi, New Hampshire, New Mexico, Ohio, Texas, and Washington for a total of $475 million, according to news releases and settlement documents from attorneys general in those states. The Massachusetts settlement, which was signed Sept. 23, brings Centene\u2019s pharmacy services settlement total to at least $489 million. Other states have also settled with Centene, but the settlement amounts \u2014 and the states themselves \u2014 have not been publicly disclosed.<\/p>\n

Centene set aside $1.25 billion in 2021 to resolve the pharmacy benefit manager settlements in \u201caffected states,\u201d according to a July filing<\/a> with the U.S. Securities and Exchange Commission that did not specify how many states.<\/p>\n

Florida and South Carolina have signed legal agreements with a Mississippi-based firm, Liston & Deas, that has represented other states in their pharmacy benefit inquiries into Centene.<\/p>\n

Pharmacy benefit managers in general have drawn increasing scrutiny and criticism. The Federal Trade Commission announced in June<\/a> that it was launching an investigation into the pharmacy benefit management industry and its impact on consumer access to prescription drugs and medication costs.<\/p>\n

This story was produced by KHN<\/a>, which publishes California Healthline<\/a>, an editorially independent service of the California Health Care Foundation<\/a>.<\/em><\/p>\n