Centene Corp., a major health insurance company, has faced serious allegations over the past few years regarding overcharging Medicaid programs in Ohio and Mississippi for prescription drugs. More than three years ago, the company settled these allegations, but the fallout continues as at least 20 states have reached settlements with Centene concerning its pharmacy benefit manager operations, which manage medications for Medicaid patients. Recently, Arizona joined this list, though the details of its settlement remain undisclosed.
Overall, Centene has agreed to pay over $1 billion in settlements, according to Cohen Milstein, a law firm involved in these cases. In 2024, Centene reported a staggering $163 billion in revenue, primarily from government health programs like Medicaid and Medicare. Notably, the company has not admitted to any wrongdoing in these settlements.
Currently, two states—Georgia and Florida—have yet to finalize their settlements with Centene. Georgia’s government, under Governor Brian Kemp, hired a law firm in 2019 to investigate the state’s pharmacy benefit operations, but a settlement has not yet been reached. Meanwhile, Florida’s attorney general’s office hired the same law firm in 2021 to look into allegations of overbilling by Centene. However, officials in Florida have not clarified whether they are still negotiating, have reached a settlement, or have dropped the case altogether.
The lack of transparency surrounding these negotiations is concerning. Since these deals are mostly happening outside of the court system, the public has little insight into the discussions between state law firms and Centene.
Centene’s operations have come under increased scrutiny, not just from individual states but also nationally, as pharmacy benefit managers are being criticized for practices that inflate drug costs or pocket discounts. In light of these issues, Centene has revamped its pharmacy benefit management operations.
If Georgia were to reach a settlement, it could be significant for the state. California’s settlement with Centene was the largest publicly disclosed at $215 million, while Georgia could potentially secure a deal similar to Ohio’s $88 million settlement. Some advocates argue that the state should aggressively pursue a resolution, urging Attorney General Chris Carr to take a strong stance against Centene, similar to how his office handles fraud cases involving Medicaid.
Political contributions from Centene have also raised eyebrows. Both Carr and Kemp received substantial donations from the company and its executives, part of a larger $26.9 million contribution to state politicians across 33 states from 2015 to 2022. Since then, Centene has continued to donate to candidates in Florida and Georgia.
As the situation unfolds, both Georgia and Florida remain in a delicate position regarding their negotiations with Centene. While the company has expressed its willingness to settle, the outcomes for these states are still uncertain, leaving many questions about the future of Medicaid funding and oversight.