Sunday, April 2, 2023

AG's Office Investigating Parent Company of State's Medicaid Provider, Western Sky

Centene Corporation Has Settled for Over $100 Million In Several Other States


Medicaid in New Mexico is big business. Over $5 billion in business. That's according to a legislative analysis of program costs for Centennial Care 2.0, which are expected to reach $5.7 billion this fiscal year in New Mexico.

In January, the state of New Hampshire reached a $21.1 million settlement with a Missouri company called Centene Corporation over the inaccurate reporting of pharmacy benefit services costs, according to the state's attorney general's office.

In New Mexico, Western Sky Community Care, one of three Medicaid providers, is owned by Centene. In 2019, the state awarded a contract to Western Sky and 85,860 New Mexicans are enrolled with the provider. Currently, Western Sky employs over 450 employees in New Mexico. Both New Mexico Attorney General Hector Balderas and State Auditor Brian Colón have been investigating the state's Medicaid pharmacy benefit manager practices since early 2020. "Our office is actively investigating this critical area, in addition to receiving a referral from State Auditor Brian Colón, and we are nearing a conclusion that will benefit New Mexico," said the AG's office in a statement.

Centene and its affiliates Granite State Health Plan, Inc. and NH Healthy Families, Inc. are responsible for one of three health plans in New Hampshire’s Medicaid Care Management Program. The state began investigating the costs and billing practices, including the pricing of prescription drugs, after similar investigations in other states became public.

The St. Louis-based Centene Corp., in the settlement agreement, denied liability, any wrongdoing, and any violation of any federal or state statute.

Snapshot of Medicaid in New Mexico

Medicaid is a hybrid program funded by both the state and federal governments that is primarily intended to serve people of low income. It is completely separate from Medicare, which is funded entirely by the federal government and is primarily intended to serve people over the age of 65. Prior to the pandemic, New Mexico was third in the nation for Medicaid enrollment. Then in January of 2021, New Mexico slid into first place, leading the U.S. in the percentage of residents who were enrolled in Medicaid. According to the Department of Human Services, as of November 2021, there were 950,685 residents that received Medicaid, a 6.08 percent increase from November 2020.

Centene's Settlements Elsewhere

Last year, Centene settled with several other states following a two-year investigation into whether the firm had overcharged Medicaid for prescriptions. Kansas in December reached a $27.6 million settlement and Mississippi and Ohio in June settled lawsuits against Centene for a total of nearly $144 million.


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