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Cetene kuti alipire Texas $166 miliyoni pobweza mitengo ya mankhwala • Missouri Independent

Kampani yayikulu ya inshuwaransi yazaumoyo Centene Corp yavomera kulipira $165.6 miliyoni ku boma la Texas kuti athetse zomwe akuti idalipira pulogalamu ya Medicaid m’boma pantchito zama pharmacy.

Ndilo malipiro aakulu kwambiri odziwika ndi inshuwaransi yayikulu kwambiri ya Medicaid pamitengo yamitengo yamankhwala. Mgwirizanowu udasainidwa pa Julayi 11 koma sunalengezedwe poyera mpaka Lolemba pambuyo pomwe a Kaiser Health News adapeza kopi yachigwirizanocho kudzera pa pempho la mbiri ya anthu aku Texas ndikuyamba kufunsa mafunso.

Mgwirizanowu umapangitsa Texas kukhala dziko locheperako la 12 kuti lithe kubweza zolipiritsa ku pharmacy ndi Centene yochokera ku St. Louis.

Cetene Lolemba sanayankhe pempho kangapo kuti apereke ndemanga pa kukhazikitsidwa kwa Texas.

Koma adakana zolakwika m’malo ambiri, ndipo Purezidenti wa Centene ndi COO Brent Leighton adanena chaka chatha kuti malo okhala ku Ohio ndi Mississippi akuwonetsa “kudzipereka kwa kampani yopanga chithandizo chamankhwala kumaloko, kosavuta komanso kowonekera” ndikulola kuti ipitilize ntchito yake. . “Kuganizira mosalekeza pakupereka zotsatira zapamwamba kwa mamembala athu.”

Mayiko ambiri amachita mgwirizano ndi makampani a inshuwaransi ngati Cetene kuti athandizire anthu olumala kapena omwe amapeza ndalama zochepa pamapulogalamu awo a Medicaid, omwe amalipidwa limodzi ndi okhometsa misonkho aboma ndi boma. M’maboma ambiri, kampani ya inshuwaransi imayang’anira mankhwala omwe amaperekedwa ndi dokotala kudzera mwa otchedwa pharmacy benefits manager, kapena PBM, pamitengo yotsika. Oyang’anira zopindulitsa amakhala ngati mkhalapakati pakati pa opanga mankhwala ndi makampani a inshuwaransi yazaumoyo komanso ngati mkhalapakati pakati pa mapulani azaumoyo ndi malo ogulitsa mankhwala. Cetene apereka mautumiki onsewa m’maboma angapo.

Medicaid idapereka nsanja yayikulu pakukula kwa Cetene ndi ndalama. Kampaniyi ndi inshuwaransi yayikulu kwambiri padziko lonse ya Medicaid, yopereka inshuwaransi yaumoyo kwa olembetsa 15.4 miliyoni padziko lonse lapansi.

Mayiko angapo atsatira milandu yotsutsana ndi mkulu wa bizinesi ya pharmacy ku Cetene, ponena kuti idalipira mopambanitsa mapulogalamu ake a Medicaid a mankhwala olembedwa ndi dokotala komanso ntchito zama pharmacy. Chiwerengero chonse cha mayiko sichidziwika kwa anthu. Cetene adakhazikika ku Arkansas, Illinois, Kansas, Mississippi, New Hampshire, New Mexico, Ohio, Texas ndi Washington ndalama zokwana $475 miliyoni, malinga ndi nkhani zomwe zatulutsidwa komanso zikalata zokhazikika kuchokera kwa maloya akuluakulu m’maiko amenewo. Maboma ena atatu ndi ndalama zomwe adakhazikitsa sizinafotokozedwe ndi Cetene kapena mayiko omwe.

Kukhazikika koyamba kwa kampaniyi kudabwera mu 2021 ndi Ohio ndi Mississippi. Centene ya $88 miliyoni idavomera kulipira Ohio inali ndalama yayikulu kwambiri yokhazikika pagulu lisanachitike ndi Texas.

Joy Mattingly, pulofesa wothandizira pa University of Maryland School of Pharmacy, adati momwe kampaniyo idachita mopambanitsa, kapena kulephera kukwaniritsa zomwe adagwirizana, sizinaululidwe m’malo okhala. “Pali njira zambiri zomwe mungawonjezere mtengo wa Medicaid,” adatero Mattingly. “N’zodabwitsa kwambiri kuti pali mayiko ambiri.”

Kukhazikika kwa Texas sikukuyembekezeka kukhala malipiro omaliza a PBM ku Cetene. M’mafayilo a Julayi ndi US Securities and Exchange Commission, Centene adalemba kuti “zokambirana zili m’kati kuti apeze chigamulo chotsimikizika” chazovuta zolipira mankhwala “m’maiko ena omwe akhudzidwa” koma sanatchule kuti ndi mayiko ati. Idapatula $ 1.25 biliyoni mu 2021 kuti athetse ma manejala opindulitsa pazamankhwala.

Mwa maiko ena, mwina ndi California, yomwe ikufufuza ntchito ya Cetene popereka phindu la pharmacy kwa olembetsa a Medicaid, KHN idanenanso koyamba mu Epulo. Florida ndi South Carolina asayina mapangano azamalamulo ndi a Liston & Deas omwe amakhala ku Mississippi, omwe adayimira mayiko ena, kuphatikiza Texas, pakufunsa kwawo za phindu la mankhwala a Cetene.

Komabe, kukhazikikako sikunapangitse kuthetsa ubale wamalonda. Ku Ohio ndi Mississippi, kampaniyo idakonzanso makontrakitala oyang’aniridwa ndi boma pambuyo pothetsa zonena za phindu lamankhwala.

Ndipo sabata yatha, Centene adalengeza kuti Texas idakonzanso mgwirizano wa kampani ya ku Texas, Superior HealthPlan, kuti ipereke chithandizo chamankhwala kwa ana ndi achichepere – ngakhale kuti mwezi wa Julayi udagwirizana pakuwongolera mankhwala. Cetene sanaulule zandalama za contract yatsopanoyi.

Gawo lomwe silinatchulidwe la kukhazikitsidwa kwa mankhwala achipatala ku Texas likuyembekezeka kupita ku boma la federal chifukwa cha ntchito yake yothandizira ndalama za Medicaid. Pangano la Cetene ndi Texas likufuna kuti kampaniyo ilipire theka la ndalama zomwe zabweza mu Ogasiti.

Antonio Ciaccia, pulezidenti wa 3 Axis Advisors, kampani yolangizira yomwe yakhala ikugwira ntchito ndi Liston & Deas pa nkhani zolipiritsa mankhwala osokoneza bongo, adati Cetene mwina adavomera kulipira ndalama zambiri ku Texas kuposa ku Ohio chifukwa cha kuchuluka kwa mankhwala omwe amalembedwa kumeneko.

“Zomwe tapeza pankhaniyi zimatumiza uthenga womveka kwa opereka chithandizo kuti Texas ikuyembekeza kuwonekera kwa anzawo a Medicaid monga momwe malamulo aku Texas amafunira,” adatero Attorney General Ken Paxton m’mawu ake. Ofesiyo sinafotokoze chifukwa chake kukhazikikako sikunaululidwe kale.

Oyang’anira maubwino a pharmacy ambiri akhala akuwunikiridwa komanso kutsutsidwa. Bungwe la Federal Trade Commission lidalengeza mu June kuti lidayamba kufufuza zamakampani owongolera mapindu a pharmacy komanso momwe zimakhudzira ogula kupeza mankhwala omwe amaperekedwa ndi mankhwala komanso mtengo wamankhwala.

“Mukuwona kuzindikira komwe kukukulirakulira kuti iyi ndi gawo lofunika kwambiri la vuto logulira mankhwala m’dziko lathu,” adatero Erin Trish, pulofesa wothandizira pa University of Southern California School of Pharmacy. “Iyi ndi bizinesi yolumikizana kwambiri komanso yosachita bwino yomwe imabisika mwachinsinsi komanso mwachinsinsi kwa zaka khumi kapena kuposerapo.”

Rebecca Grapevine anathandizira nkhaniyi.

Nkhaniyi idapangidwa ndi KHN, yomwe imasindikiza California Healthline, ntchito yodziyimira payokha ya California Health Care Foundation.

KHN (Kaiser Health News) ndi chipinda chankhani cha dziko chomwe chimatulutsa utolankhani wozama pazaumoyo. Pamodzi ndi kusanthula mfundo ndi kafukufuku, KHN ndi m’modzi mwa atatu oyendetsa KFF (Kaiser Family Foundation). KFF ndi bungwe lopanda phindu lomwe limapereka chidziwitso pazaumoyo kudziko lonse.

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