Lawsuit alleges former Centene execs defrauded state Medicaid programs

A lawsuit from a pension fund holding Centene stock accused former executives of conspiring to defraud state Medicaid programs, the St. Louis Business Journal reported Dec. 21. 

The lawsuit accuses the former execs of violating its Medicaid managed care contracts and federal and state law. 

When Centene acquired Health Net in 2016, the company received favorable reimbursements and discounts for prescription drugs because of Health Net's contract with CVS Caremark, the lawsuit alleges. 

The payer did not disclose its arrangements with CVS Caremark, and instead reported "inflated expenditures" to state Medicaid agencies, thereby overcharging them, the plaintiffs allege. 

The suit alleges five former executives breached their fiduciary duties, and also names several members of the board of directors. Centene is a nominal defendant in the case. 

CVS Caremark is not named as a defendant. 

Centene paid $307.5 million to seven states in 2022 to settle allegations it overbilled state Medicaid programs for pharmacy services. 

The St. Louis Business Journal said the former executives named in the lawsuit could not be reached for comment. 

Read more here.

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