Wikipedia

Centene Corporation

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Centene Corporation is a publicly traded managed care company based in St. Louis, Missouri, which is an intermediary for government-sponsored and privately insured healthcare programs. Centene ranked No. 25 on the 2023 Fortune 500.[2]

Centene Corporation
Company typePublic
Industry
Founded1984; 40 years ago (1984)
FounderElizabeth "Betty" Brinn
Headquarters
St. Louis, Missouri
,
U.S.
Key people
  • Sarah London (CEO)
  • Susan Smith (COO)
Products
Revenue Increase US$154 billion (2023)
Increase US$2.93 billion (2023)
Increase US$2.70 billion (2023)
Total assets Increase US$84.6 billion (2023)
Total equity Increase US$25.9 billion (2023)
Number of employees
c. 67,700 (2023)
Websitewww.centene.com Edit this at Wikidata
Footnotes / references
[1]

History

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Centene was founded by Elizabeth Brinn as the Managed Health Services in Milwaukee, Wisconsin, in 1984.[3] After the death of Brinn, the non-profit organization was sold to investors, with the proceeds going to the Betty Brinn Foundation, which subsequently became a major shareholder in Centene. In 1996, Michael Neidorff joined the company as chief executive.[4]

Centene went public in December 2001.[5] In 2006, the firm acquired US Script, a pharmacy benefits manager.[6] The company later merged US Script with subsidiaries to form its Envolve divisions.[6] In 2011, the firm formed Centurion, a provider of correctional health care services, as a joint venture with MHM Services.[6] In 2018, it acquired MHM Services, including its stake in Centurion.[6] Centene began offering state-run Medicaid programs through Affordable Care Act exchanges in 2014.[7]

On July 2, 2015, Centene announced it would acquire Health Net.[8][9][10] In March 2016, it finalized its acquisition [11] On September 12, 2017, it announced that it would acquire Fidelis Care, a nonprofit insurer in New York, for US$3.75 billion.[12] In March 2019, it announced plans to acquire WellCare for US$17.3 billion.[13][14] On January 4, 2021, it was announced that it would acquire Magellan Health for $2.2 billion.[15] On January 4, 2022, the acquisition was completed.[16]

In the United Kingdom, Centene began to acquire local healthcare services in 2017.[17] In 2019, Centene, through its subsidiary MH Services, took a 40% stake in Circle Health,[17] as part of a deal which created a national network of over 50 private hospitals.[18] Centene gained full control of Circle Health in July 2021,[19] and sold the business to PureHealth in August 2023.[20]

In early 2021, Operose Health, a UK subsidiary of Centene, took over a group of London practices, AT Medics.[21]

In May 2022, Centene announced that they had divested two pharmacy organisations as the company exited the pharmacy benefit management business. Centene divested Magellan Rx and PANTHERx Rare for a total of $2.8 billion.[22]

Business segments

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The main lines of Centene include:

Leadership

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In June 2021, an article in the Ohio Capital Journal reported that CEO Michael Neidorff was the highest paid healthcare executive in the United States in 2020, earning nearly $25 million.[28][29][30]

In December 2021, Politan Capital Management took a $900 million stake in Centene. Following the agreement, CEO Michael Neidorff announced plans to retire by the end of 2022.[31]

In March 2022, Sarah London was named chief executive officer of the company, replacing Neidorff.[32]

Controversies

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In 2014, Fox News alleged that Superior HealthPlan of Texas denied coverage of an infant's surgery for brain cancer at Texas Children's Hospital. Superior HealthPlan is a joint-venture of Centene and Community Health Centers Network LP, which provides services for Medicaid recipients.[33] The article reported that Superior HealthPlan had previously paid healthcare claims for the infant at the hospital, although Superior HealthPlan stated that it did not cover procedures at the facility.[34] Three days after the article was published, Superior HealthPlan reversed its decision and covered the surgery.[35]

In January 2018, a class action lawsuit accused Centene's Ambetter marketplace healthcare plans of misleading enrollees about plan benefits.[36][37] According to the lawsuit, people who bought Centene's plans had difficulty finding medical providers that accepted patients covered under Centene's policies.[38]

In December 2018, Centene was sued by two pension funds alleging that Centene's acquisition of Health Net resulted in damages to Centene and exposed the company to potential liability. The suit also alleged that Centene concealed that Health Net owed approximately $1B in past tax liabilities to California and was under investigation for Medicare fraud at the time of the acquisition.[39]

In 2022 Operose Health had almost 600,000 NHS patients and was the largest supplier of GP services to the NHS. It was accused of putting patients at risk by prioritising profit, specifically by hiring physician associates, because they were cheaper than GPs. At Operose practices the average number of full time equivalent GPs per patients is about half the average in English practices. Sir Sam Everington said he was worried to see physician associates saying they were not receiving the supervision they needed. The practice had a backlog of thousands of medical test results and hospital letters on their computer systems. Operose said 97% of its practices were rated "good" or "outstanding" by the Care Quality Commission.[40]

Settlements

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In April 2021, Health Net Federal Services, a subsidiary of Centene, agreed to pay $97M to settle allegations that it had duplicated or inflated claims submitted to the Department of Veterans Affairs.[41]

Between June 2021 and January 2022, Centene agreed to settlements with several states on behalf of their subsidiary, Envolve, a pharmacy benefit manager, including Ohio, Mississippi, Illinois, Arkansas, and New Hampshire to resolve allegations of overpayments to the PBM from the states' Medicaid programs.[42] The settlements have totaled over $191 million.[43][44][45]

In December 2021, Centene agreed to pay $27.6M to Kansas to settle allegations that it had failed to disclose discounts and used other strategies to obtain more profit from Kansas' Medicaid program.[46]

In September of 2022, Centene Corporation will pay more than $14 million to Massachusetts's to resolve claims that it overcharged the state Medicaid program, MassHealth, millions of dollars for pharmacy benefits and services provided by subsidiary companies.[47]

See also

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References

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  1. ^ "Centene Corporation 2023 Annual Report (Form 10-K)". sec.gov. U.S. Securities and Exchange Commission. February 20, 2024.
  2. ^ "Centene 2022 Fortune 500". Fortune. Retrieved June 6, 2023.
  3. ^ Trewyn, Phill (February 17, 2002). "Managed Health's new parent plots Medicaid growth". www.bizjournals.com. Archived from the original on February 2, 2003. Retrieved September 9, 2021.
  4. ^ "Health services: Michael Neidorff, Centene Corp". St. Louis Business Journal. June 16, 2002.
  5. ^ "Centene launches IPO at $14 per share". www.bizjournals.com. December 13, 2001. Archived from the original on January 31, 2003. Retrieved September 9, 2021.
  6. ^ a b c d Japsen, Bruce. "Centene Invests Stake In Pharmacy Benefit Manager RxAdvance". Forbes. Retrieved September 9, 2021.
  7. ^ "Centene's Neidorff: WellCare acquisition has cleared final state approvals". FierceHealthcare. December 5, 2019. Retrieved September 9, 2021.
  8. ^ "Corporation - Home". Centene.com.
  9. ^ "Centene to Combine with Health Net in Transaction Valued at Approximately $6.8 Billion" (PDF). July 4, 2015. Archived from the original (PDF) on July 4, 2015.
  10. ^ "Centene completes Health Net deal after protracted review". Modernhealthcare.com. March 24, 2016.
  11. ^ Bray, Chad (July 2, 2015). "Centene to Acquire Its Managed Care Rival Health Net for $6.8 Billion". The New York Times. ISSN 0362-4331. Retrieved September 9, 2021.
  12. ^ Mathews, Anna Wilde; Armental, Maria (September 12, 2017). "Centene Agrees to Buy Fidelis Care in $3.75 Billion Deal". The Wall Street Journal. New York City, United States. Retrieved September 13, 2017.
  13. ^ Tobin, Ben. "Centene to buy smaller rival WellCare Health Plans in deal worth $17.3 billion". USA TODAY. Retrieved September 9, 2021.
  14. ^ Ward, Brendan (January 23, 2020). "Centene completes $17B acquisition of Tampa's WellCare". www.bizjournals.com. Retrieved September 9, 2021.
  15. ^ "Centene acquires Phoenix-based Magellan Health". Retrieved January 4, 2021.
  16. ^ "Centene Completes Acquisition of Magellan Health, Establishing a Leading Behavioral Health Platform at a Critical Time". PR Newswire. January 4, 2022. Retrieved January 4, 2022.
  17. ^ a b "US company in takeover of network of GP practices". The Lowdown. February 4, 2021. Retrieved April 11, 2021.
  18. ^ Plimmer, Gill (November 29, 2019). "Takeover of BMI Healthcare by hedge fund-backed Circle Health is part of expansion push". Financial Times. Retrieved December 2, 2019.
  19. ^ Davies, Maria (July 14, 2021). "Circle Health announces major investment programme as US Centene takes over ownership". LaingBuisson News. Retrieved February 5, 2022.
  20. ^ "PureHealth acquires UK private healthcare group for $1.2 billion". www.clinicalservicesjournal.com. August 31, 2023. Retrieved August 31, 2023.
  21. ^ Kollewe, Julia (February 26, 2021). "NHS GP practice operator with 500,000 patients passes into hands of US health insurer". The Guardian.
  22. ^ "Centene divesting two pharmacy businesses for combined $2.8 billion". Healthcare Finance. May 6, 2022. Retrieved May 9, 2022.
  23. ^ "Centene slapped with lawsuit over provider networks in ACA exchange plans". FierceHealthcare. January 12, 2018. Retrieved June 22, 2019.
  24. ^ "Centene completes Fidelis Care buy". Healthcare Dive. Retrieved September 9, 2021.
  25. ^ "How the WellCare acquisition is driving Centene's approach to Medicare Advantage". FierceHealthcare. October 8, 2020. Retrieved September 9, 2021.
  26. ^ "DOD Releases Draft RFP for New $58 Billion Health Care Contracts". Bloomberg Government. Retrieved September 9, 2021.
  27. ^ Japsen, Bruce. "Centene Acquisition Bolsters Its Prison Healthcare Business". Forbes. Retrieved September 9, 2021.
  28. ^ Schladen, Marty (June 28, 2021). "Lavishly paid and unapologetic. Company at center of Medicaid scandal focuses on profits". Ohio Capital Journal. Retrieved June 28, 2021.
  29. ^ "18 highest-paid CEOs in healthcare". www.beckershospitalreview.com. Retrieved June 28, 2021.
  30. ^ Minemyer, Paige (April 30, 2021). "Centene CEO Neidorff raked in nearly $25M last year. Take a look what other insurance execs earned". Fierce Healthcare. Retrieved February 23, 2022.
  31. ^ Japsen, Bruce. "Centene's Neidorff To Step Down As CEO Amid Deal With Activist Investor". Forbes. Retrieved February 23, 2022.
  32. ^ Japsen, Bruce. "Centene Promotes Tech And Healthcare Strategist Sarah London To CEO Job". Forbes. Retrieved April 20, 2022.
  33. ^ "Superior HealthPlan names CEO". www.bizjournals.com. March 20, 2002. Archived from the original on September 18, 2002. Retrieved September 9, 2021.
  34. ^ Corbin, Cristina (March 24, 2015). "Parents fight insurance company to keep baby's cancer surgery docs". Fox News. Retrieved September 9, 2021.
  35. ^ Corbin, Cristina (July 12, 2014). "Texas baby improves after brain surgery allowed by insurer's change of heart". Foxnews.com.
  36. ^ Small, Leslie (January 12, 2018). "Centene slapped with lawsuit over provider networks in ACA exchange plans". Fierce Healthcare. Retrieved February 23, 2022.
  37. ^ Bryant, Meg (January 12, 2018). "Lawsuit accuses Centene of misleading customers on narrow ACA plans". Healthcare Dive. Retrieved April 26, 2019.
  38. ^ Abelson, Reed (January 11, 2018). "Health Insurer Centene Is Sued Over Lack of Medical Coverage". The New York Times. ISSN 0362-4331. Retrieved February 23, 2022.
  39. ^ Anderson, Mark (December 24, 2018). "Lawsuit accuses Centene of concealing Health Net problems from shareholders". www.bizjournals.com. Retrieved February 23, 2022.
  40. ^ "UK's biggest GP chain replacing doctors with less qualified staff". BBC. June 13, 2022. Retrieved June 13, 2022.
  41. ^ "Health Net Federal Services Pays over $97M for Overstated Billings to the VA". www.justice.gov. April 6, 2021. Retrieved February 23, 2022.
  42. ^ Minemyer, Paige (June 14, 2021). "Centene to pay more than $140M to settle Medicaid overpayment allegations in Ohio, Mississippi". Fierce Healthcare. Retrieved February 23, 2022.
  43. ^ Minemyer, Paige (June 14, 2021). "Centene to pay more than $140M to settle Medicaid overpayment allegations in Ohio, Mississippi". Fierce Healthcare. Retrieved April 20, 2022.
  44. ^ Minemyer, Paige (September 30, 2021). "Centene to pay more than $71M to settle Medicaid overpayment cases in Illinois, Arkansas". Fierce Healthcare. Retrieved April 20, 2022.
  45. ^ Raymond, Nate (January 7, 2022). "Centene to pay $21 mln to settle New Hampshire overcharge claims". Reuters. Retrieved April 20, 2022.
  46. ^ Minemyer, Paige (December 7, 2021). "Centene to pay $27.6M to settle PBM investigation in Kansas". Fierce Healthcare. Retrieved February 23, 2022.
  47. ^ "AG Healey Secures $14 Million in Settlement With Nation's Largest Medicaid Managed Care Insurer | Mass.gov". www.mass.gov. Retrieved November 15, 2022.
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