Health care giant to pay Washington $19M to resolve allegations of Medicaid fraud

The Washington attorney general says it has secured a mammoth monetary settlement with a health care company that it said was not sharing money properly with Washington’s Medicaid Program.

The company, Centene, will have to pay $19 million to Washington state, and Attorney General Bob Ferguson said it would be the second-largest Medicaid fraud recovery in Washington state history.

On Wednesday morning, the attorney general’s office announced that Centene would pay millions back to Washington. Ferguson explained that Washington’s health care authority has a contract with Centene subsidiary Coordinated Care of Washington, and that the subsidiary helps the state manage its Medicaid program — part of that management involves negotiating prescription drug prices.

Centene was able to get drugs and get discounts, whether it was through rebates or price reductions.

Ferguson said Centene was supposed to pass that money/savings on to the state of Washington but the AG accused the company of pocketing millions: “the cost to the consumer is the cost to the consumer but when there’s fraud in the system, especially at this scale, there’s a cost for everybody in this state — because Centene, a Fortune 50 company, was essentially pocketing all those discounts, all those savings rather than pass them on to the state which is their obligation. Those funds of course are used by the state to provide critical services for vulnerable populations all across our state.”

The settlement according to the attorney general’s office breaks down like this: Washington recovered a total of $18,999,999.80 in the resolution with Centene. As part of the resolution, an additional $13 million from Centene will be paid to the federal government for the administration of Medicaid in Washington state. Centene had resolved cases with 10 other states over the same conduct, according to the attorney general.

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In a statement on the resolution of this issue, a Centene spokesperson said: “We respect the deep and critically important relationships we have with our state partners. This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making the delivery of healthcare local, simple and transparent. Importantly, this allows us to continue our relentless focus on delivering high-quality outcomes to our members.”

The attorney general did say the only decision with a higher dollar mark when it comes to Medicaid fraud was an agreement reached with Wyeth back in 2016. That resolution involved $22.9 million.

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