Image Credit: John Partipilo

By Adam Friedman [Tennessee Lookout -CC BY-NC-ND 4.0] –

Health care services company Centene is undergoing an aggressive push to become one of the companies to manage TennCare plans, Tennessee’s Medicaid program. But since 2021, the company has settled allegations that it overbilled or fraudulent charged Medicaid programs in 17 of the 30 states it has operated.

This week, the Tennessee Legislature’s Fiscal Review Committee will vote on whether to accept its TennCare contracts with BlueCross BlueShield, UnitedHealthcare, and Amerigroup/Elevance Health. The approval vote comes after House Republicans on the committee delayed the process last month to seek more time for “due diligence” to review allowing Centene’s Rhythm Health to receive a contract.

BlueCross BlueShield, UnitedHealthcare and Amerigroup/Elevance Health are all some the largest spenders in Tennessee politics. But so is Centene, which has recently upped its spending, mainly on lobbying.

St. Louis, Mo.-based Centene is one of the largest companies in the United States and is primarily focused on administering government health care programs. It manages a prison health care service and sells insurance plans through the Affordable Care Act marketplace, Medicare Advantage and Medicaid.

In Tennessee, it previously operated a correctional health program, called Centurion, and currently runs a Medicare service, called WellCare.

For Medicaid, the company usually sets up a subsidiary in each state it operates to contract with a state government to administer its version of the program. In Tennessee, Centene named its subsidiary Rhythm Health, but failed to win one of the TennCare managed care contracts two years ago during the bidding process.

Centene’s Rhythm Health then sued the state, and has since lost two appeals and a legislative effort by House Speaker Cameron Sexton to make Centene the fourth state contractor with TennCare.

When Sexton advocated for the Centene’s inclusion in TennCare, he said it was because he wanted to create a more open process. Adding, it felt like TennCare’s contracting lacked transparency, leaving insurers to feel like the state decided which companies would get contracts before the bidding started.

Centene’s Medicaid settlements

Since 2021, the health care management company has paid out $937.8 million in settlements for Medicaid fraud in 17 of the 30 states it has operated.

The numbers below indicate the amount of the settlements with each state for Medicaid fraud.

Washington State: $33.3 Million

Oregon: $17 Million

California: $215 Million

Nevada: $11.3 Million

New Mexico: $13.7 Million

Texas: $165.6 Million

Arkansas: $15.2 Million

Louisiana: $64.2 Million

Mississippi: $55.5 Million

Kansas: $27.6 Million

Nebraska: $29.3 Million

Iowa: $44.4 Million

Illinois: $56.7 Million

Indiana: $65.6 Million

Ohio: $88.3 Million

New Hampshire: $21.1 Million

Massachusetts: $14 Million