Medicaid Fraud Case Costs Centene $166 Million Settlement In Texas
The health insurance company was facing claims it overcharged Texas' Medicaid program for pharmacy services. Also in the news: care gaps exposed in NCQA health plan quality ratings and Medicare solutions for issues with the kidney dialysis system.
KHN:
Centene To Pay $166 Million To Texas In Medicaid Drug Pricing Settlement
Health insurance giant Centene Corp. has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. It’s the biggest known payout by the nation’s largest Medicaid insurer over its drug pricing practices. The deal was signed July 11 but hadn’t been publicly announced until Monday after KHN obtained a copy of the settlement through a Texas public records request and began asking questions. The agreement makes Texas at least the 12th state to settle pharmacy billing claims with St. Louis-based Centene. (Miller and Young, 9/19)
Modern Healthcare:
Centene Settles Medicaid Fraud Allegations In Texas For $166M
Centene did not admit liability for violating the Texas Medicaid Fraud Prevention Act and maintains that its business practices were lawful, Attorney General Ken Paxton said in a news release Monday. The attorney general’s office did not immediately respond to interview requests. (Tepper, 9/19)
In Medicare news —
Modern Healthcare:
NCQA Health Plan Quality Ratings Show Care Gaps
Medicare plans scored better in 2021 than Medicaid and commercial plans in key quality areas measured by the National Committee for Quality Assurance. The committee rates Medicare, Medicaid and commercial plans annually on a five-star scale, using data from the Healthcare Effectiveness Data and Information Set, the Consumer Assessment of Healthcare Providers and Systems' Health Plan Survey, and the Centers for Medicare and Medicaid Services’ Health Outcomes Survey. (Devereaux, 9/19)
Stat:
The Kidney Dialysis System Has Problems, So Medicare Is Jumping In
Chronic kidney disease, already a problem affecting millions of Americans, is only expected to become more prevalent as the country ages. For those with the disease, a transplant is the ideal treatment, but dialysis is their reality. (Cueto, 9/19)
