AG Healey Secures $14 Million In Settlement With Nation's Largest Medicaid Managed Care Insurer

BOSTON, Massachusetts, Sept. 30 -- Massachusetts Attorney General Maura Healey issued the following news release on Sept. 29, 2022:

Attorney General Maura Healey today announced a major settlement with the nation's largest Medicaid managed care insurer to resolve claims that it overcharged the state Medicaid program, MassHealth, millions of dollars for pharmacy benefits and services provided by subsidiary companies.

Under the terms of the settlement agreement, Centene Corporation will pay more than $14 million to MassHealth. This is the latest in a series of settlements Centene has reached around the country related to state Medicaid programs as the corporation exits the pharmacy benefit management industry.

"This settlement is a significant result in our work to protect taxpayer dollars and the integrity of our MassHealth program," said AG Healey. "We 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."

"Managing the MassHealth program with integrity has been a core objective of this administration in order to ensure that public dollars are efficiently and effectively utilized," said Health and Human Services Secretary Marylou Sudders. "I appreciate the Attorney General's commitment to ensuring that MassHealth is fairly charged for benefits while we serve some of the most vulnerable in our state."

Following a series of investigations and settlements by state officials across the country, AG Healey's Office reviewed the operations of Centene in Massachusetts, including its pharmacy benefits manager (PBM), Envolve Pharmacy Solutions, Inc. This review discovered irregularities in the pricing and reporting of pharmacy benefits and services to MassHealth by Centene's subsidiary companies.

Most health insurance plans use pharmacy benefit managers as intermediaries between prescription drug plans, pharmacies and drug manufacturers. PBMs determine which prescription drugs are covered by insurance plans and how much the drugs should cost. As a PBM for Centene-owned CeltiCare's Medicaid managed care organization, Envolve administered pharmacy benefits for MassHealth members. The AG's Office alleges that Envolve and Centene failed to disclose or pass on some retail discount fees to MassHealth, which inflated fees and drug costs reported to the Commonwealth.

This matter was handled by Managing Attorney Ian Marinoff of the AG's Medicaid Fraud Division. Assistance was provided by Investigations Supervisor Chris Cecchini also from the Medicaid Fraud Division.

The AG's Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25 percent is funded by the Commonwealth of Massachusetts.

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Original text here: https://www.mass.gov/news/ag-healey-secures-14-million-in-settlement-with-nations-largest-medicaid-managed-care-insurer