Centene agrees to pay Massachusetts $14 million over Medicaid prescription claims
Massachusetts has become the latest state to settle with health insurance giant Centene Corp. over allegations that it overbilled the state’s Medicaid program for pharmacy services. St. Louis-based Centene, the nation’s largest Medicaid managed-care insurer, will pay $14.2 million, according to Massachusetts Attorney General Maura Healey. Before the Massachusetts agreement, Centene had settled with Ohio, […]
As new Medicaid prescription program nears, some Ohio pharmacists are worried
Ohio’s community pharmacists are still worried that the state Medicaid program might drive them out of business — and deprive some communities of access to medicine. After years of complaints about under-payment and possible profiteering off of prescription drugs, the legislature in 2019 directed the Department of Medicaid to undertake a bold reform. Instead of […]
Federal Trade Commission to investigate pharmacy middlemen
After years of pleading, the Federal Trade Commission on Tuesday voted to investigate the practices of some of the nation’s largest companies. They’re accused of using their dominance in myriad sectors of the health care space to drive up costs, drive out competition and reap profits. Four of the six companies to be investigated have […]
That’s privileged: Medicaid won’t say what it did to justify denying records
The Ohio Department of Medicaid is denying public access to oversight reports submitted by its billion-dollar managed-care contractors. But it won’t describe the process it used in determining that information in the reports qualifies as trade secrets. That information is privileged, said a spokeswoman for the department, which claims to value transparency. Even though some […]
Ohio Medicaid claims it’s more transparent than other states
After refusing to disclose federal watchdog reports, the Ohio Department of Medicaid last week claimed that the relevant information it “makes available to the public appears to include at least as much, if not more information.” It pointed to some of that information Monday, but it’s hard to evaluate whether it meets or exceeds that […]
Ohio Medicaid made a commitment. Let’s hold them to their word
Medicaid is the second largest health care provider in Ohio, serving more than three million of our state’s most at risk and underserved people across all communities. In our state’s most populous counties with the densest urban cores – Franklin, Cuyahoga and Hamilton Counties – between 30% and 35% of residents are enrolled in Medicaid. […]
With big Medicaid changes looming, Ohio pharmacists complain of a lack of details
The Ohio Department of Medicaid plans to radically change the way it does business in July, but a group that helped motivate the reform effort says it hasn't provided some fundamental details. Some members of that group, the state's community pharmacists, say those details could determine whether they can stay in business — and whether some small towns become pharmacy deserts.
CEO of health company accused of bilking Ohio taxpayers stepping down
Six months after setting aside $1.25 billion to settle fraud claims with Ohio and 21 other states, the CEO of the nation’s largest Medicaid managed-care company has announced his retirement. Despite the scandal, Ohio continues to contract with the company. And although Centene denies it’s the case, the problems might have played into the CEO’s […]
Are companies still inflating the cost of Medicaid drugs?
Last week, Ohio Medicaid Director Maureen Corcoran revealed something with potentially far-reaching implications: When her department calculates how much to pay managed-care companies she’s not sure if it it knows the true cost of the prescription drugs for which it is shelling out billions. If the drug middlemen hired by Ohio’s Medicaid managed-care contractors are […]
After Ohio scandal, Medicaid managed-care giant to exit the pharmacy business
Centene, the nation’s largest Medicaid managed-care company, is planning to stop its work as a pharmacy middleman, or pharmacy benefit manager. Executives last week said the company is issuing a $30 billion request for proposals from an outside contractor to take over the work. The news comes after Ohio Attorney General Dave Yost sued the […]
Medicaid chief stresses transparency, won’t talk about her investments in giant contractors
Medicaid chief stresses transparency, won't talk about her investments in giant contractors.
Aetna, an Ohio Medicaid contractor, accused of denying kids care in Pennsylvania
In a case that could have implications for Ohio, a Pennsylvania whistleblower is accusing Aetna of making it impossible for the parents of some kids on Medicaid to find doctors. The insurer then pocketed money from the state for services not rendered, the suit alleges. Aetna denies the charges. The case is relevant here because […]