An investigation, led by the Mississippi State Auditor & Attorney General’s Offices, into the largest Medicaid managed care organization in the country will return more than $55 million to the state.
Centene, the parent company of Magnolia Health, reached a settlement with Mississippi following allegations of overpayments through pharmacy benefits as a part of Mississippi’s Medicaid program. The investigation began in 2019 following suspicions that, according to state officials, Pharmacy Benefit Managers (PBMs) were inflating their bills. After a of review invoices produced by Centene, Attorney General Lynn Fitch and State Auditor Shad White explained that the PBMs were charging Medicaid more than the allowed price cap.
“I do not care how large or powerful the company is, Mississippi taxpayers deserve to get what they paid for when the state spends money on prescription drugs, and we will stand up for the taxpayers if they do not get a square deal,” White said. “I’m grateful for the joint work between my staff, the data analysts, and the Attorney General’s team for bringing this to a conclusion.”
Jerry Mitchell with the Mississippi Center for Investigative Reporting stated the the Mississippi Division of Medicaid has paid out over $1.1 billion to Centene between 2016-2020 for pharmacy services.
The $55.5 million settlement represents one of the largest civil settlements following an investigation by the Office of the State Auditor in Mississippi history.
“My Office is business-friendly, and I firmly believe that businesses that operate in good faith are good partners in meeting the needs of our state,” Fitch said. “However, I am in this Office to serve the people of Mississippi, and I fully intend to make sure they are not being cheated by Centene or anyone else. This settlement makes clear that the days of hiding behind a convoluted flow of money and numbers are over. And, I appreciate the work of Auditor White and his staff in helping achieve this success for the people.”
In addition to the settlement, the agreement calls for Centene to “provide full transparency related to the adjudication and payment of all pharmacy benefit claims, including the provision of such information as is required to permit the Department of Medicaid to discern, on a claims level, the exact amount paid to the pharmacy for each pharmaceutical claim.”
Rep. Becky Currie has been a vocal critic of Centene and discussed her gripes during a recent appearance on the Paul Gallo Show on SuperTalk Mississippi.
A similar was launched by Ohio’s Attorney General in March. Centene paid $88 million settlement to Ohio following claims that the company “utilized a web of subcontractors for the provision of pharmacy benefits in order to misrepresent pharmacy costs.”
In the ‘no fault settlements’, Centene denies any liability for the alleged practices.
“We respect the deep and critically important relationships we have with our state partners,” Brent Layton, Centene President of Health Plans, Markets and Products, said. “These agreements reflect the significance we place on addressing their concerns and our ongoing commitment to making the delivery of healthcare local, simple and transparent. Importantly, putting these issues behind us allows us to continue our relentless focus on delivering high-quality outcomes to our members.”
The company also stated that it has recorded a reserve estimate of $1.1 billion related to this issue to “bring final resolution to these concerns in other affected states.”