AG: Health care giant to pay $19M for overcharging WA Medicaid program
OLYMPIA, Wash. - Attorney General (AG) Bob Ferguson announced on Wednesday that the Fortune 50 health care giant Centene will pay the state of Washington $19 million for overcharging the state Medicaid program. Ferguson is calling this Medicaid fraud recovery the second-largest in state history.
"Medicaid dollars are a precious resource meant to fund care for the most vulnerable among us," Ferguson said. "My office works to ensure that these dollars go where they are intended — not toward fraud."
(Photo by Stephen Brashear/Getty Images)
According to the AG’s Office, the state of Washington will recover a total of $18,999,999.80 from Centene. The office says the total amount will go back to the state through the state Medicaid Fraud Penalty account. In addition, Centene will pay the federal government an added $13 million for administration of Medicaid in Washington.
In Wednesday’s press release, the AG’s office explained how their lawyers and the Washington State Health Care Authority (HCA) investigated Centene.
For background information, the HCA has contracts with organizations like Coordinated Care of Washington (CCW), which is a Centene subsidiary, to manage its Medicaid program. CCW contracts with pharmacy benefit managers, who negotiate rebates and discounts on the cost of prescription drugs.
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The AG’s Office and the Washington State Health Care Authority (HCA) began investigating pharmacy benefit managers in 2019 after a whistleblower handed over information revealing that they were not disclosing true pharmacy benefits and services costs. According to the AG’s office, Centene allegedly failed to pass on discounts it received to the state Medicaid program and inflated dispensing fees.
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"We commend the AG for their continued partnership in stewarding state resources," said HCA Director Sue Birch. "Controlling health care expenditures, especially prescription drug costs, remains a top priority for HCA."
According to the AG’s Office, Centene has resolved cases with 10 other states over the same conduct.
Ferguson’s resolution with Wyeth in 2016 is the only Medicaid fraud recovery larger than Centene.