In a strongly worded response, Centene repudiated the lawsuit filed by the Ohio attorney general that accuses the payer of maximizing profits at the expense of the state’s Medicaid department.
The lawsuit, which is sealed, “reflects a misunderstanding of the admittedly complex world of Medicaid accounting and billing in which Managed Care Organizations and Pharmacy Benefit Managers such as [the] Defendants operate,” the health insurer wrote in its response filed April 2.
Last month, Ohio AG Dave Yost filed a lawsuit alleging that Centene subsidiary Buckeye Health Plan, a managed care organization, used three subcontractors to provide pharmacy benefits in order to inflate costs, resulting in millions of dollars in overpayments made by the state’s Medicaid department.
“Corporate greed has led Centene and its wholly-owned subsidiaries to fleece taxpayers out of millions,” Yost said in a news release.
Now, St. Louis-based Centene is fighting back, saying that the state’s complaint is based on “factual errors or misstatements.”
For example, the lawsuit alleges that Buckeye Health Plan constructed a three-tiered pharmacy benefit manager structure to hide information from the state’s Medicaid department. But Centene claims it disclosed the structure in writing and answered all of the department’s questions.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Another accusation from the lawsuit is that Envolve Health Solutions — one of the companies that Buckeye contracted with — did not provide “substantive” pharmacy benefit manager services. Centene claims this is untrue, as Envolve played a leading role in many of those services, including formulary management and benefit design.
Further, Centene is asking the court to unseal the original complaint, stating, “the disclosure of Plaintiffs’ allegations in their March 11 media release, resulting in false allegations being disseminated statewide against Defendants, destroyed any value the Court’s original sealing order had.”
But Ohio’s AG Yost said they were forced to seal the suit.
“The last thing I wanted was a sealed lawsuit — this is, after all the people’s business,” said Yost in an email. “We were forced to sign a non-disclosure agreement in order to get the data. If Centene is not going to hold our feet to the fire on the NDA, let the sun shine in! We remain confident of our complaint and the righteousness of our cause.”
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