More than three years ago, health insurance giant Centene Corp. settled allegations that it overcharged Medicaid programs in Ohio and Mississippi related to prescription drug billing.
Now at least 20 states have settled with Centene over its pharmacy benefit manager operation that coordinated the medications for Medicaid patients. Arizona was among the most recent to join the ranks, settling for an undisclosed payout, Richie Taylor, a spokesperson for the states attorney general, told 窪蹋勛圖厙 News in December.
All told, Centene has agreed to pay more than $1 billion in settlements, according to , one of the law firms representing states in the agreements. Meanwhile, St. Louis-based Centene reported $163 billion in revenue in 2024, largely proceeds from government health programs for Medicaid, Medicare, and the Affordable Care Act. The health care company has admitted no wrongdoing in the settlements.
Two state holdouts appear to remain: Georgia has yet to settle with Centene, even though the administration of Gov. Brian Kemp in 2019 to investigate state pharmacy benefit operations.
Florida hired the same law firm in 2021 to pursue overbilling allegations involving Centene, but state officials declined to answer a reporters questions about whether Florida has dropped the case, reached an undisclosed settlement, or is still discussing the issue.
Neither state has publicly disclosed whats standing in the way of potentially tens of millions of dollars in Centene payouts, or whether negotiations are taking place. Because the deals are largely , the process between the private law firms hired by states and Centene remains generally out of public view.
Centene spokespeople did not return multiple phone calls and emails asking for updates. In 2022, the company said it was working on settlements with Georgia and eight other states, having reached deals with 13 others. And in a Securities and Exchange Commission , Centene said it had reached settlements with the vast majority of states impacted over the operations of its former pharmacy benefits manager.
Georgia has taken disproportionately long compared to other states, said Greg Reybold, a vice president of the , which represents independent pharmacies.
Meanwhile, Centenes Georgia Medicaid plan, the Peach State Health Plan, lost its bid last year to continue its longtime participation in a Georgia Medicaid program in which for Medicaid recipients for a set fee from the government rather than for each medical service provided. The company, which has been part of the contract since the managed-care program began in 2006, over the contract awards, saying that the process was mismanaged, rife with errors and reckless practices.
Nationally, pharmacy benefit managers, or PBMs, have come under increased scrutiny over accusations of pocketing discounts on medications or inflating costs in the years since Centene started settling its Medicaid-related allegations. Members of Congress have proposed major policy constraints on PBMs. Centene has since overhauled its PBM operation.
Still, a possible settlement in Georgia could bring in significant money to the state. California had the largest publicly disclosed settlement at $215 million, split with the federal government, but a settlement with Georgia could be in the range of the $88 million that Centene agreed to pay in the Ohio dispute, Reybold said.
The state should aggressively pursue a settlement with Centene, said Roland Behm, co-founder of the , who is a critic of Centene and its Georgia Medicaid plan. Behm said state Attorney General Chris Carr should take the same tenacious prosecutorial action against Centene that Carrs agency takes against individuals involved in fraud against Medicaid, the federal-state program that provides health insurance coverage for those with low incomes or disabilities.
Carrs office said in 2022 that it stood ready to represent Georgia in settlement negotiations with Centene. Carr, a Republican who has announced hes running for governor in 2026, received tens of thousands of dollars in campaign contributions from Centene, its subsidiaries, and its executives, as did Kemp, a fellow Republican, 窪蹋勛圖厙 News reported in 2022. Contributions to the Kemp and Carr campaigns were part of more than $26.9 million that Centene, its subsidiaries, its top executives, and their spouses donated to state politicians in 33 states, to their political parties, and to nonprofit fundraising groups from 2015 through 2022.
Since 2022, the company and its political action committee have contributed, combined, at least $2 million more to the campaigns of Florida and Georgia candidates of both political parties, along with state party organizations and political committees, according to state campaign finance records.
When asked about a possible settlement, a spokesperson for Carr, Kara Murray, directed a reporter to the Georgia Department of Community Health, which administers Medicaid.
Fiona Roberts, a spokesperson for that agency, then told 窪蹋勛圖厙 News that the department is actively pursuing options to ensure regulatory compliance with the states contract. She declined to comment further.
Floridas attorney generals office directed a reporter to the state agency that oversees Medicaid, the Florida Agency for Health Care Administration. But that agency did not respond to multiple phone calls and emails requesting comment.
Rebecca Grapevine of Healthbeat contributed to this article.
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