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Ohio awards contract worth billions to the same company it accused of fraud and was later paid $88 million as a result

Ohio is again in business with a company that only recently it was accusing of massive fraud. The state’s leaders seem reluctant to explain why. Two months ago, Ohio Attorney General Dave Yost announced that Centene, the largest Medicaid managed-care provider in the United States, would pay Ohio $88.3 million to settle a lawsuit claiming that Centene had defrauded taxpayers of tens of millions of dollars. 

In a regulatory filing, the company said its overall settlement of those and expected fraud claims was much bigger than that. It set aside $1.3 billion to settle such claims across the country, the filing said. An analysis commissioned by the Ohio Department of Medicaid showed that in 2017, drug middlemen owned by Centene was charging the state $20 million for services that it was already paying CVS for. It’s a claim they both denied.

Tyrone’s Commentary:

There are probably details the public is not privy to, but lets assume for a second that isn’t the case. If I had to do it all over again, I would pick up golf. It seems relationships matter more than results for some.

The suit AG Yost filed against Centene in March made a similar allegation. It said that Buckeye had defrauded taxpayers of tens of millions of dollars by working through a chain of middlemen to overcharge for prescription drugs. On Friday — a day when government entities are known to put out news they want to bury — Medicaid issued a brief press release. It touted the news that Centene’s Buckeye would become the state’s seventh managed care provider by saying it “will give customers more options.”

It didn’t make any mention of fraud; it just said the lawsuit was settled, so it’s time to get back into business with Centene.

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Tyrone Squires, MBA, CPBS

I am the proud founder and managing director of TransparentRx, a fiduciary-model PBM based in Las Vegas, Nevada. We help health plan sponsors reduce pharmacy spend, by as much as 50%, without cutting benefits or shifting costs to employees.

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