Centene Corp, a major health insurance company, settled allegations of overcharging Medicaid programs in Ohio and Mississippi three years ago. Since then, at least 20 states have also settled with Centene over its pharmacy benefit manager operations, coordinating medications for Medicaid patients. The settlements total over $1 billion, despite Centene reporting $163 billion in revenue in 2024 from government health programs.
Georgia and Florida are among the few states that have not yet settled with Centene. Georgia hired a law firm to investigate pharmacy benefit operations, while Florida pursued overbilling allegations. The negotiations and reasons for delays are not publicly disclosed, as the settlements are happening outside the court system.
Despite efforts to reach settlements, Centene has not provided updates on the progress. The company mentioned working on settlements with Georgia and eight other states in 2022. Pharmacy benefit managers have faced increased scrutiny for various practices, leading to policy constraints proposed by members of Congress.
A possible settlement with Georgia could bring significant funds to the state, similar to the $88 million settlement in Ohio. Advocates urge the state to aggressively pursue a settlement with Centene. Contributions from Centene and its executives to political campaigns have raised concerns about potential conflicts of interest in settlement negotiations.
State agencies in Georgia and Florida have not provided detailed comments on the settlement discussions. The Department of Community Health in Georgia is actively pursuing options to ensure regulatory compliance with the state’s contract, while the Florida Agency for Health Care Administration did not respond to inquiries.
Overall, the settlements with Centene highlight the complexities of negotiating with a major healthcare company over alleged misconduct. The outcomes of the remaining settlements will have significant implications for Medicaid programs and the healthcare industry as a whole.
