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    Reba Chenoweth
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    Ohio AG Dave Yost announces $88M settlement with Centene for double-billing Medicaid drugs

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    Ohio AG Dave Yost announces $88M settlement with Centene for double-billing Medicaid drugs

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    195 views19 pages

    Buckeye Ohio Final Settlement Release

    Uploaded by

    Reba Chenoweth
    Ohio AG Dave Yost announces $88M settlement with Centene for double-billing Medicaid drugs

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
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    INTHE COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO ‘OHIO DEPARTMENT OF MEDICAID, etal. | CASENO.: 210 V001536 Plintit, | SUDGE CHRISTOPHER M. BROWN BUCKEYE HEALTH PLAN COMMUNITY ‘SOLUTIONS, INC, eta! ‘SETTLEMENT AGREEMENT AND. RELEASE Defendants ‘SRICLLEMENY AGREBMENT AND RELEASE This Setement Agreement is made and entered into tht 14° day of Jane 2021, among Centene Corporation nd each ots subsidiaries (Centene") including but not ited, Buckeye Health Plo, In, (“Buckeye Health Pla’), Buckeye Health Plan Community Solutions, Ine, (Buckeye, Centene Management Corporation, ("CMC"), and Eavolve Pharmacy Soltons, ae, (Bavolve") (collectively refered 0 Contene Entities") andthe Ate General on behalf of the Stat of Oho, the Ohio Departnant of Maze and aloe state departments, agencies, and bureaus of the State of Ohio for which se Centene Enis proved any pharmacy benefit o service, or which pido reimbursed any Cente Baty for providing such a pharmacy benefit of service (hreinaer collectively fered tas “Attorney Geneal,"“Stateof Ono” othe “State inconnetion with the lawsuit captioned, ki Departmen of Medicaid and State of Ohio. Cenene Conporation, Buckeye Health Plan Communi Soltis, Inc, and Enolve Pharmacy Soatios Inc, Case No, 21CVO01536, exiginally filed in the Court of Common Plas, Civil Division, Franklin County, Ohio Brown, 1) (he “Ohi Action”, removed to Unie Sas District Cou, Souther District of Ohio, Eastern Division, Case No, 21-1502 (Watton) and upon the jit ‘ling ofthe State and Cente atts nding ror oppsitn tthe Site's motion readme ‘ote cour (the Centene Bates andthe State of Ohio, colesvey refered ta the “Parties "Selling Paris), This Setement Agreements intended bythe Sting Pats to fly, nally sod forever resolve, discharge and set lcs asserted inthe Ohio Astin andthe potential lan ring from orn anyway ltd the pharmacy busines ofthe Cater Ets in Ohio uring he defied time period umning fom Janay 1, 2016, tothe eeeton ofthis Setement Agreement (the “Setemen) WHEREAS, the State file ts Complit in state court on March 11,202, alleging tht (Buckeye breached its Provider Agreement with he Ohio Department of Medssd(“ODM") by, 2 among otter things Buckeye and Envolve deceptively receiving payments, or payments in mounts 0 which hey ware not entitled andlor fling reports ete to the wick under the Provider Agrement (i) Buckeye and Envolveviolsed Ohio Inw, inching O.RC. $5164.35, ty, among ote things, Buckeye submiting encounter data to ODM tt mirecested the ots ‘of phanocy services consenting oBavolve's improper pricing practi, an accepting payment in exces of those to which it was entitled as result ofthese improper practises; and (i) Centene ‘Corprstion and its subsidiaries Buckeye and Envolve conspied to commit, among other things. the breach and violatons reference in subpar (i and i above; WHEREAS, tbe Ceneve Enis () deny each and all ofthe claims and slegations of ‘wrongdoing made by the State in the Ohio Action and maintain tat they bave meritorious defenses i) deny all charges of wrongcongor hibit agains itarsing ut of any ofthe conduct, statements, aso oissions alleged or hat could have been allege, nthe Ohio Action; and (i) cxpresily deny lsbiliy, any wrongdoing, andor any violation of any federal or sate statute or regulon or commen aw WHEREAS, the Centene Enitiesecopize the importance of providing high quality and coneletive pharmacy benef services othe Stat and the State's need for transparency around the cows associated with those services; WHEREAS, white the State do not pute that the Cee tia may hve provided quality pharmacy benfit services othe Sat, he Sate requies ful eansprency fam he Centene tis eguding the costs and fees associated with those services, [WHEREAS the Parties have investigated the fats have analyzed the relevent gas ceguing the claims and defenses nerd in the Ohio Acton, sd have engage in otion prostie; WHEREAS, the Pais have each considered the cons and days stsocated withthe conminued posecatioy and defense of the Ohio Actin, and have reched an agreement 0 eae ‘he Ohio Actin and ny an alllaims, le, uled, or which could be fied, rising fm orin any ‘way relating tothe Centene Ents’ provision of phamacy benefits o other phamsacy benefit services in connection with any Heath Care Coverage provided ty Cenlene Entities andor conde legedor ta could have been alleged inthe Ohio Action: WHEREAS, tho Parties elev the Setement st forth erin) voids the unceraintis oflitigton and assures thatthe benefits refested Neen are obtained ad (ii fi, resonable an adequne and in he best interest ofthe poope ofthe Sate of Ohi, WHEREAS, the Swe sod Centone Bis agree that nether tis Agreenent, or any statement mae in he negotiation thereof shall be deemed or consid to be «concession a8 10 any lain, a adrmison, evidence of my vilaton of ny saute ow, evidence any silty or wrongdoing by one or more Centene Ents or Rleasess,o evidence ofthe rt of ay ofthe claims or aegatons made by the Parts inthe Ohio Action, WHEREAS, arm'stength setlement negotiations have taken place between the Centene nities and the Stat; and WHEREAS, the Pais understand tat i thee is ele to sts the tems ofthe Setlement, the Parcs may need to sek juicia intervention, an the Court's retention of sistiction best serves the interests othe Parties and promotes the objsivs ofthe Seterent NOW, THEREFORE, 17 IS HEREBY AGREED by and among te State and Centene Entities, by and tough thee respective counsel, that the Ohio Acton shal be Hy and fly setled leased, and dismised with prejudice at st forth below ‘A. Delctions. As used inthis Agreement the following capitalized terms have the meanings specitid below, ()“Agreenent* or “Seulement Agreement” means this Setlement ‘Aggoemet and Exhibits atached hereto, any. (©) “Agreet Order of Dismissal” means the order that incaporates the Setlement Agreamet, is prevented to the Court for approval andor enty anc that confers the Courts continued jurisdiction over the enforcement of the Seteent Agreement. (©) "Contes Enties" means Centene Corporation and each of it subsidiaries whose stvites related to or supported directly or indirectly, Ihe provision {of pharnacy benefits or oer pharmacy bensfit services apt of, oi connecton with the provision of Health Care Coverap,inlsing but not limited to, Buckeye Health Plan, Inc, Buckeye HealtPlar Community Solutions Inc, Centene Management Corporati, and EnvoWe Pharmscy Solutions ne. (@ “Covert Conduct” means any an all acts, conduct, omisicas, events ot fransectons, whether known of unknown and whether Gszovered 0° unciscovered, during the pec fom January 1, 2016 upto snd including the Effective Dt, relating to te operation or delivery of, 0: payment fr, all phusnacy benefit products by any Centene Entity as rat of, or in {conection with the provision of Fath Care Coverage, including but not limited te: () the payment or reimbursement (0 or fam any ste

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