More than three years ago, Health Insurance Giant Centene Corp. resolved allegations that it had overcharged Medicaid programs in Ohio and Mississippi in connection with prescription drug claims.
At least 20 states are currently settling in Centene in the operation of pharmacy benefits managers coordinated with Medicaid patients’ medications. Arizona settled on private payments and settled in Richie Taylor, a spokesman for the state attorney general, told KFF Health News in December, and joined the latest rank.
Centrene has agreed to pay a settlement of more than $1 billion, according to Cohen Milstein, one of the law firms representing the agreement’s state. Meanwhile, St. Louis-based Centene reported revenue of $163 billion in 2024. This is primarily profitable from Medicaid, Medicare, and Affordable Care Act government health programs. Healthcare companies have admitted that they do not admit fraud to the settlement.
The two state holdouts appear to remain. Georgia has yet to settle in Centene, despite Gov. Brian Kemp’s management hired law firm Liston & DEA in 2019 to investigate the welfare operations of state pharmacies.
Florida hired the same law firm in 2021 to pursue excessive allegations, including the Center, but state officials refused to answer reporters’ questions about whether Florida has dropped the case, reached a private settlement, or whether they are discussing the issue.
Neither state has publicly disclosed whether the Centnay payments are in the way that could be tens of millions of dollars or whether negotiations are being made. Because transactions occur largely outside the court system, the process between the state and private law firms employed by Centrene is generally out of public view.
A Centene spokesperson did not return multiple calls or emails asking for updates. In 2022, the company said it was working on settlements in Georgia and eight other states, reaching a deal with 13 people. And in an October Securities and Exchange Commission application, Centrene said it had reached a village that had “major states affected” over the operation of its former pharmacy benefits managers.
Georgia “is taking it disproportionately longer than other states,” said Greg Raybold, vice president of the American Pharmacy Cooperative, which represents independent pharmacies.
Meanwhile, Centene’s Georgia Medicaid Plan, Peach State Health Plan, lost its bid last year to continue its long-standing participation in the Georgia Medicaid program, which covers the care of Medicaid recipients at a set fee from the government, rather than per-health services offered. The company, which has been part of the contract since the managed care program was launched in 2006, filed a protest at the contract award, saying the process is “mismanaged and filled with errors and reckless practices.”
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Nationally, pharmacy benefits managers, or PBMs, have been under surveillance over a number of years of charges over inflation of drug therapy discounts or inflation costs since Centre began resolving Medicaid-related claims. Members of the Congress have proposed key policy constraints regarding the PBM. Centene has since overhauled the PBM operation.
Still, the possibility of a settlement in Georgia could bring a lot of money to the state. California had split with the federal government and had its biggest public settlement at $215 million, but the settlement with Georgia could be in the $88 million range that Senten agreed to pay in the Ohio dispute.
The state should actively pursue a settlement with the Center, said Roland Boehm, co-founder of the Georgia Mental Health Policy Partnership, a critic of Centrene and its Georgia Medicaid plan. Behm said Attorney General Chris Carr should file “the same tenacious prosecutorial lawsuits” against individuals involved in fraud against Medicaid, a federal state program that provides health insurance coverage to people with low incomes or disabilities.
Carr’s Office said in 2022 it is ready to represent Georgia in settlement negotiations with Centene. Kerr, a Republican who announced he would run for governor in 2026, received tens of thousands of dollars in campaign contributions from Centene, its subsidiaries and its executives, similar to KEMP reported by KFF Health News in 2022. to 33 state politicians, political parties, and non-profit fundraising groups from 2015 to 2022.
Since 2022, the company and its political action committees have contributed to at least $2 million and at least $2 million along with candidates from Florida and Georgia and candidates from both parties.
A spokesman for Carr, Kara Murray, led a reporter for the Georgia Regional Health Department, which manages Medicaid.
Fiona Roberts, a spokesman for the agency, told KFF Health News that the department is “actively pursuing options to ensure regulatory compliance with state contracts.” She declined to comment further.
The Florida Attorney General’s Office directed reporters for a state agency that oversees Medicaid, the Florida Department of Health Care Administration. However, the agency did not respond to multiple calls or emails requesting comment.
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KFF Health News is a national newsroom that produces detailed journalism on health issues. Along with policy analysis and voting, KFF Health News is one of KFF’s three major operating programs. KFF is a donated non-profit organization that provides the country with information on health issues.
