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DBJ: Centene Corp. Reaches $165.6M Settlement with Texas Over Pharmacy Benefit Practices

September 20, 2022 James Drew of the St. Louis Business Journal

St. Louis-based Centene Corp. will pay $165.6 million to Texas to resolve an investigation into whether the corporation’s business practices violated the state’s Medicaid fraud prevention law.

As part of the settlement, Centene made no admission of liability and maintained that its business practices were lawful.

The 24-page Texas agreement is the latest in which Centene has agreed to pay millions of dollars to resolve claims that its subsidiaries overcharged state Medicaid programs for pharmacy benefit management services.

“Protecting taxpayer funds and the financial integrity of the Texas Medicaid Program is a top priority for my office,” Attorney General Ken Paxton said in a statement Monday. “The results we achieved, in this case, send a clear message to providers that Texas expects transparency from its Medicaid partners as required by Texas law.”

The settlement – which was reached in July and announced on Monday by Paxton – says the state of Texas, Hurst and their respective counsel will determine the allocation of the $165.6 million.

Reached for comment, a Centene spokesperson said in an email: “We respect the deep and critically important relationships we have with our state partners. 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. Importantly, this allows us to continue our relentless focus on delivering high-quality outcomes to our members.”

In a June 2021 regulatory filing, Centene said it had set aside $1.1 billion in reserve related to allegations in several states regarding its pharmacy benefit management practices.

For more DFW business news, please visit the Dallas Business Journal.

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