OLYMPIA – Final week, Washington Lawyer Common Bob Ferguson introduced that managed well being care big Centene can pay $19 million to Washington state. The fee resolves allegations that the Fortune 50 firm overcharged the state Medicaid program for pharmacy profit administration providers.
The decision is the second-largest Medicaid fraud restoration for Washington state.
In line with Ferguson’s workplace, the Well being Care Authority (HCA) contracts with managed care organizations like Coordinated Care of Washington, a Centene subsidiary, to handle its Medicaid program.
The Lawyer Common’s Workplace and HCA’s Program Integrity Group started investigating pharmacy profit managers in 2019 after a whistleblower supplied data that they had been failing to reveal true pharmacy advantages and providers prices. The whistleblower alleged that Centene did not cross on reductions it obtained to the state Medicaid program and inflated meting out charges. The whistleblower later filed a separate declare towards Centene.
The decision was the results of a joint investigation carried out by the Washington Lawyer Common’s Workplace’s Medicaid Fraud Management Division and the Well being Care Authority.
“Medicaid {dollars} are a valuable useful resource meant to fund take care of essentially the most susceptible amongst us,” Ferguson mentioned. “My workplace works to make sure that these {dollars} go the place they’re supposed — not towards fraud.”
As a part of the decision, Washington recovers a complete of $18,999,999.80. The cash will return to the state by way of the state Medicaid Fraud Penalty Account.
Centene has additionally resolved instances with 10 different states over the identical conduct.
