Dive Brief:
- Centene reached a $44.4 million deal with Iowa over allegations that it overcharged the state’s Medicaid program for pharmacy benefit services, representing the latest deal in a string of settlements with states.
- Iowa Attorney General Tom Miller alleged that Centene and its pharmacy benefit manager Envolve failed to pass on some retail discounts to the program, which inflated fees and costs for Iowans.
- Under the deal, Centene has agreed to transparency requirements, according to the AG’s office. Centene will have to disclose the exact amount it pays to pharmacies for every pharmaceutical claim.
Dive Insight:
The settlement in Iowa is the latest to surface publicly alleging that Centene overcharged for pharmacy services.
The payer previously disclosed that it has reached deals with 13 other states, but has not named all the states it has agreed to pay.
Centene has paid more than $520 million in settlements
Miller said his office began investigating after learning of settlements elsewhere.
His investigators ultimately found irregularities in costs reported to the state, Miller said in a statement.
“Ensuring these dollars are used as intended means that our health care system is in a better spot to help our residents,” Miller said in a statement.
Three managed care organizations provide 805,000 Iowans with Medicaid coverage. Centene is one of those organizations and does business there as Iowa Total Care.
“This 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,” Centene said in a statement.
Centene is the nation’s largest Medicaid managed care organizations, providing coverage to nearly 16 million people with low incomes, according to its latest quarterly filing.
The St. Louis-based insurer previously disclosed that it had set aside $1.25 billion in a reserve to fund future settlements.
Most recently, the state of Oregon said Centene agreed to pay it $17 million to resolve similar allegations.