Ohio sues Centene entities for breach of Medicaid contracts

Published 1:21 am Tuesday, March 16, 2021

COLUMBUS — Ohio has sued health-care giant Centene Corp. for an elaborate scheme to maximize company profits at the expense of the Ohio Department of Medicaid (ODM) and the state of Ohio, Attorney General Dave Yost announced recently.

The lawsuit alleges that Centene subsidiary Buckeye Health Plan utilized a web of subcontractors for the provision of pharmacy benefits in order to misrepresent pharmacy costs, resulting in millions of dollars of overpayments by ODM.

“Corporate greed has led Centene and its wholly owned subsidiaries to fleece taxpayers out of millions. This conspiracy to obtain Medicaid payments through deceptive means stops now,” Attorney General Yost said. “My office has worked tirelessly to untangle this complex scheme, and we are confident that Centene and its affiliates have materially breached their obligations both to the Department of Medicaid and the state of Ohio.”

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The Department of Medicaid administers a medical assistance plan that provides coverage to about 2.9 million Ohioans, and it does so through the use of Managed Care Organizations (MCOs). One such MCO, Centene’s Buckeye Health Plan, administered its pharmacy benefit via sister companies Envolve Health Solutions and Health Net Pharmacy Solutions. The practice of subcontracting to more than one Pharmacy Benefit Manager (PBM) raised questions about Buckeye Health Plan’s business practices and, ultimately, Centene’s.