Centene (CNC), a provider of managed healthcare plans to the under and uninsured, has disclosed a lawsuit that alleges the company used its PBM business to bilk taxpayers and intentionally drive up the cost of healthcare for the poor. In its latest 10-Q, Centene revealed the civil suit was filed by the state of Ohio on March 11, 2021:

“The complaint alleges breaches of contract with the Ohio Department of Medicaid relating to the provision of pharmacy benefit management (PBM) services and violations of Ohio law relating to such contracts…”

The complaint accuses Centene of double dipping and other actions designed to drive up the costs of its healthcare services by:

“...(i) seeking payment for services already reimbursed, (ii) not accurately disclosing to the Ohio Department of Medicaid the true cost of the PBM services and (iii) inflating dispensing fees for prescription drugs.”

Ohio’s Attorney General says Centene has fleeced taxpayers out of millions of dollars. Though CNC says the allegations can be easily explained away, the legal trouble is already jeopardizing future revenue. Later in the filing, Centene disclosed future contracts in the state have been paused due to the civil action filed:

“For example, in April 2021, the Ohio Department of Medicaid deferred its decision on Buckeye Community Health Plan’s bid in its Medicaid managed care contract awards pending further consideration of the lawsuit filed against us by the State of Ohio, and the Department may ultimately decide following its deferral to deny that bid.”

The greater risk to investors is that other state attorneys general compare notes and file similar actions in their jurisdictions like they have against big technology firms. Centene said as much, revealing the scrutiny as a new risk that has the potential to spread beyond Ohio:

“Other states are reviewing the practices of PBM service providers, including us, and could bring claims against us.”