Centene refutes Ohio AG’s lawsuit, says it displays misunderstanding of Medicaid billing


In a strongly worded response, Centene repudiated the lawsuit filed by the Ohio legal professional common that accuses the payer of maximizing income on the expense of the state’s Medicaid division.

The lawsuit, which is sealed, “displays a misunderstanding of the admittedly advanced world of Medicaid accounting and billing during which Managed Care Organizations and Pharmacy Profit Managers equivalent to [the] Defendants function,” the well being insurer wrote in its response filed April 2.

Final month, Ohio AG Dave Yost filed a lawsuit alleging that Centene subsidiary Buckeye Well being Plan, a managed care group, used three subcontractors to offer pharmacy advantages so as to inflate prices, leading to thousands and thousands of {dollars} in overpayments made by the state’s Medicaid division.

“Company greed has led Centene and its wholly-owned subsidiaries to fleece taxpayers out of thousands and thousands,” Yost stated in a information launch.

Now, St. Louis-based Centene is combating again, saying that the state’s grievance is predicated on “factual errors or misstatements.”

For instance, the lawsuit alleges that Buckeye Well being Plan constructed a three-tiered pharmacy profit supervisor construction to cover info from the state’s Medicaid division. However Centene claims it disclosed the construction in writing and answered the entire division’s questions.

One other accusation from the lawsuit is that Envolve Well being Options — one of many corporations that Buckeye contracted with — didn’t present “substantive” pharmacy profit supervisor companies. Centene claims that is unfaithful, as Envolve performed a number one position in a lot of these companies, together with formulary administration and profit design.

Additional, Centene is asking the courtroom to unseal the unique grievance, stating, “the disclosure of Plaintiffs’ allegations of their March 11 media launch, leading to false allegations being disseminated statewide towards Defendants, destroyed any worth the Courtroom’s authentic sealing order had.”

However Ohio’s AG Yost stated they had been pressured to seal the swimsuit.

“The very last thing I needed was a sealed lawsuit — that is, after all of the individuals’s enterprise,” stated Yost in an e-mail. “We had been pressured to signal a non-disclosure settlement so as to get the info. If Centene isn’t going to carry our toes to the fireplace on the NDA, let the solar shine in! We stay assured of our grievance and the righteousness of our trigger.”

Photograph: designer491, Getty Pictures




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