Centene settles Medicaid fraud case with Washington state

Centene will pay $33 million to settle allegations its now-defunct pharmacy benefit manager overcharged the Washington state Medicaid program for drugs. 

The nation’s largest Medicaid insurer will pay $18.9 million to the Evergreen State and $13 million to the federal government to put an end to allegations of fraud by its former PBM, Washington Attorney General Bob Ferguson (D) announced Wednesday. Centene has settled with 11 states over accusations its pharmacy benefits arm, Envolve, inflated charges, according to a news release. The attorney general’s office declined to comment on whether it was investigating other PBMs over similar allegations. 

Centene has publicly disclosed $312 million in no-fault agreements with eight states: Arkansas, Illinois, Kansas, New Hampshire, Mississippi, New Mexico, Ohio and Washington. Centene has also inked settlement deals with Louisiana, Nebraska and Nevada, a spokesperson for Ferguson’s office wrote in an email. California regulators are investigating Centene over similar fraud claims.

Attorneys general in these states did not immediately respond to interview requests about any agreements with Centene. Centene did not immediately respond to an interview request on additional settlements

Centene reserved $1.25 billion to settle PBM fraud allegations. The company exited the pharmacy business in July when it sold Magellan Rx and PANTHERx Rare in separate transactions collectively valued at $2.8 billion. By the end of the year, the insurer plans to finalize a contract with an outside PBM  to manage its $40 billion in annual pharmaceutical spending.