Centene Corporation controversies
Controversies tied to this brand in public sources. A listing is not a finding of fault.
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2022
Operose Health patient-safety criticism
Centene's UK subsidiary Operose Health faced criticism over staffing levels, use of physician associates, and backlogs involving test results and hospital correspondence. Operose stated that most of its practices received good or outstanding regulatory ratings.
2021
Health Net Federal Services claims allegations
Health Net Federal Services agreed to pay $97 million to resolve allegations concerning duplicated or inflated claims submitted to the Department of Veterans Affairs.
2021
State Medicaid pharmacy settlements
Centene and its Envolve pharmacy-benefit operations reached settlements with several states concerning alleged overpayments and related practices in Medicaid pharmacy programs.
2021
Centene settles Ohio Medicaid overbilling lawsuit
Settlement
Centene settled with Ohio for $88.3 million following accusations that it used an opaque, multi-layered billing process to retain more state Medicaid pharmacy-benefit money than it should have. The settlement resolved the dispute over the state's Medicaid pharmacy-benefit program. According to the source, the company did not admit wrongdoing as part of the settlement.
Centene settled with Ohio for $88.3 million after accusations that it used an opaque, multi-layered billing process to retain more state Medicaid pharmacy-benefit money than it should have. The article states that the company did not admit wrongdoing.
Source excerpt
The insurance giant didn't admit to doing anything wrong.
The largest Medicaid contractor in the U.S. settled with Ohio for $88.3 million, following accusations that it set up "an opaque and multi-layered billing process" to keep a larger cut of the state's money than it should have when paying for pharmacy benefits.
The contractor Buckeye Health Plan, subsidiary of Centene, manages pharmacy benefits and pays claims to pharmacists on behalf of about 435,000 Ohioans with Medicaid.
2021
Centene reaches settlement with Ohio and Mississippi
Settlement
Centene announced no-fault agreements with the attorneys general of Ohio and Mississippi to resolve state claims related to pharmacy-benefit services provided by its subsidiary Envolve Pharmacy Solutions. Under the agreements, Centene will pay $88 million to Ohio and $55 million to Mississippi. Centene denies liability for the practices described in the settlements.
Stated objective. Resolve claims made by Ohio and Mississippi related to services provided by Envolve Pharmacy Solutions.
Company response
Denial — Centene
In the settlements, the Company denies any liability for these practices.
Source excerpt
Healthcare firm Centene Corp. (CNC) announced Monday that it has reached no-fault agreements with the Attorneys General of Ohio and Mississippi to resolve claims made by the states related to services provided by Envolve Pharmacy Solutions, Inc., its pharmacy benefits manager or PBM subsidiary.
In the settlements, the Company denies any liability for these practices.
Under the terms of these agreements, Centene will pay $88 million to Ohio and $55 million to Mississippi.
2021
Centene reaches $15.2 million Arkansas Medicaid settlement
Settlement
Arkansas Attorney General Leslie Rutledge announced a $15.2 million settlement with Centene Corporation and three subsidiaries over allegations that Envolve Pharmacy Solutions reported inflated pharmacy costs to Arkansas Medicaid after failing to disclose discounts and dispensing fees. Centene must pay in two installments and provide an accounting of pharmacy benefit claims.
Source excerpt
Centene must pay the $15 million in two installments within the next 13.5 months. It also must provide an accounting of all pharmacy benefit claims, including the amount paid to pharmacies.
The settlement is also with subsidiaries Arkansas Total Care, Centene Management Company and Envolve Pharmacy Solutions.
Attorney General Leslie Rutledge announced today a $15.2 million settlement with Centene Corporation and three subsidiaries for overcharging the state Medicaid program for medication.
2020
Arkansas jury awards $9.4 million against Centene
Ruling
An Arkansas jury awarded $9.4 million to Southeastern Emergency Physicians, an affiliate of TeamHealth, finding that Centene Corporation and its insurance subsidiaries underpaid the doctors' group and breached their contract. The final award was expected to increase with attorneys' fees and interest.
Source excerpt
the jury in U.S. District Judge Brian S. Miller's court found that the defendants grossly underpaid and breached their contract with the emergency room doctors.
A six-person jury on Tuesday awarded a $9.4 million verdict on behalf of Southeastern Emergency Physicians, LLC, a group of emergency room doctors that is an affiliate of TeamHealth Inc., finding that Centene Corporation and its insurance subsidiaries systematically tried to strip the doctors' group of most of their pay.
2018
Ambetter network-access class action
A class action alleged that Ambetter enrollees were misled about plan benefits and had difficulty locating providers willing to accept their coverage.
2018
Health Net acquisition litigation
Two pension funds sued Centene, alleging that the Health Net acquisition caused corporate harm and that liabilities and investigations associated with Health Net had not been adequately disclosed.
2014
Dispute over Texas Medicaid cancer surgery coverage
Superior HealthPlan, a Centene-related Texas Medicaid plan, was reported to have denied coverage for an infant's brain-cancer surgery at Texas Children's Hospital. After public reporting, the decision was reversed and the surgery was covered.