Centene settles Medicaid fraud allegations in Texas for $166M

Centene will pay $165.6 million to settle allegations that its former pharmacy benefit manager overcharged the Texas Medicaid program for drugs. 

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.

The insurer has paid more than $553 million to settle similar allegations from attorneys general in at least 11 states: Texas, Arkansas, lllinois, Kansas, Louisiana, Mississippi, Nevada, New Hampshire, New Mexico, Ohio and Washington. California regulators are also investigating Centene over similar fraud claims. 

The nation’s largest Medicaid managed care organization has reserved a total of $1.25 billion to resolve fraud allegations related to its now-defunct Envolve PBM. 

The company exited the pharmacy business earlier this year when it sold MagellanRx and PANTHERx Rare in separate transactions collectively valued at $2.8 billion. By the end of 2022, the insurer plans to finalize a contract with an outside PBM to manage its $40 billion in annual pharmaceutical spending. 



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