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Centene Corporation, is a Fortune 50 company (ranked 26th), and is a diversified, multi-national health care enterprise that provides a portfolio of services to government-sponsored health care programs. Centene is the parent company of Health Net. It is a big player in state Medicaid drug programs – but one with a questionable record.

In recent years, the company was accused by six states of overbilling their Medicaid programs for prescription drugs and pharmacy services and settled to the tune of $264.4 million. Three other states made similar allegations and have settled with the company, but the amounts have not been disclosed. Centene, in resolving the civil actions, denied any wrongdoing.

And they now have resolved their pending case in California. This month the California Attorney General announced a settlement of more than $215 million against the Centene Corporation over allegations that the national healthcare company overcharged California’s Medi-Cal program by falsely reporting higher prescription drug costs incurred by two of its managed care plans.

In doing so, Centene is alleged to have violated the California False Claims Act. California Health & Wellness and Health Net, the two managed care plans, provide healthcare services to Medi-Cal beneficiaries in over 20 California counties.

California Department of Justice investigators found that between January 2017 and December 2018, California Health & Wellness and Health Net reported inflated figures for the costs they incurred in providing prescription drugs to patients.

Centene allegedly leveraged advantages in its pharmacy benefit manager (PBM) contracts to save its managed care plans $2.70 per prescription drug claim over the two-year period. DOJ alleges that Centene and its PBM failed to disclose or pass on these discounted fees to Medi-Cal, which inflated fees and drug costs reported to California.

The settlement amounts to a total of $215,392,758, recovers twice the value of Centene’s inflated price reporting, and ensures full restitution to the Medi-Cal program.

Nonetheless in January 2023 the California Department of Health Care Services selected Centene’s California subsidiary – Health Net of California – for direct contracts in Los Angeles and Sacramento counties, increasing the number of direct county contracts by DHCS to 10.

In total, Health Net will provide Medi-Cal managed care services in Los Angeles, Sacramento, Amador, Calaveras, Inyo, Mono, San Joaquin, Stanislaus, Tulare and Tuolumne counties. Health Net continues to serve members in Fresno, Imperial, Kings, and Madera counties via other contractual arrangements. Health Net did not receive an award ini San Diego.

More troubling is a report a few months ago by NPR Saint Luis that claims “Centene showers politicians with millions as it courts contracts and settles overbilling allegations.” One example in a sister state, involves Nevada Gov. Steve Sisolak, who they say “has accepted at least $197,000 from Centene, its subsidiaries, top executives, and their spouses since August 2018.”

They report that less than two months after Centene’s subsidiary contributions in November 2021 for his re-election were made, Nevada settled with the company over allegations the insurer overbilled the state’s Medicaid pharmacy program. The state attorney general’s office did not publicly announce the $11.3 million settlement but disclosed it in response to a public records request from KHN.

The contract went before the Nevada Board of Examiners for final approval. Sisolak is one of three voting members.

Since 2015, Centene, its subsidiaries, its top executives, and their spouses have given more than $26.9 million to state politicians in 33 states, to their political parties, and to nonprofit fundraising groups, according to a KHN analysis of IRS tax filings and data from the nonpartisan, nonprofit group OpenSecrets.

Last year, according to IRS filings that go through Sept. 30, Centene has given $2.2 million, combined, to the Republican and Democratic governors’ associations, which help elect candidates from their respective parties. And Centene gave $250,000, combined, to the Republican Attorneys General Association and its Democratic counterpart.

State attorneys general, whose campaigns are benefiting from the associations’ money, have negotiated massive settlements with Centene over accusations the company’s prescription drug programs overbilled Medicaid.

More than 20 states are investigating or have investigated Centene’s Medicaid pharmacy billing. The company has agreed to pay settlements to 13 of those states, with the total reaching about $596 million.

And Centene told KHN in October that it is working to settle with Georgia and eight more states that it didn’t identify. It has denied wrongdoing in all the investigations.