Ohio Wins $ 88 Million Prescription Drug Manager Settlement | Ohio
(The Center Square) – A nearly three-year investigation that began when Ohio Attorney General Dave Yost was the state’s auditor, resulted in a settlement of nearly $ 90 million with the one of the largest medical insurers in the state regarding Medicaid billing.
Centene Corp. agreed to pay Ohio $ 88.3 million to settle the lawsuit, which claimed the manager of drug benefits overcharged the Ohio Department of Medicaid for the drug services it provided. Yost claimed that Centene and its subsidiary, Buckeye Health Plan, had conspired to distort the costs of pharmacy services, including the cost of prescription drugs.
The Department of Medicaid administers a taxpayer-funded medical assistance plan that covers nearly 2.9 million Ohioans through the use of managed care organizations.
The settlement was the first and largest in the country obtained by a state attorney general against a drug benefit manager. The company also settled with Mississippi for $ 55 million, according to a report by Georgia Health News.
“Centene used sophisticated metrics to bill for unearned dollars – metrics known only at the highest levels of healthcare companies,” Yost said. “It took a huge effort on the part of my team to unravel this pattern – and now that we know how it works, the alarm bells should ring for anyone using similar tactics.”
Yost said most of Ohio’s prescription drug plans are managed by a drug benefits manager through their health insurance plans. PBMs, he said, are intermediaries who control the costs of prescription drugs, and they decide which prescriptions are covered by insurance.
Yost started investigating PBMs as a state auditor in 2018 and said he found they collect more for drugs compared to the actual cost of distributing the drugs.
“Centene took advantage of all of us who pay taxes to take care of the most vulnerable Ohioans,” Yost said. “This settlement is the great first step taken by Centene to restore the confidence of Ohio, and I hope they will continue on this path in good faith.”
Centene issued a statement regarding the Ohio and Mississippi settlements.
“We respect the deep and critically important relationships we have with our state partners,” said Brent Layton, president of health plans, markets and products at Centene. “These agreements reflect the importance we place on addressing their concerns and our continued commitment to making local healthcare delivery simple and transparent. Most importantly, putting these issues behind us allows us to continue to focus without focus on delivering high quality results to our members. ”