Visual analysis: Centene’s push in Tenn. comes as settlements with other states for fraud pile up

By: - November 10, 2023 6:00 am
Members of the Tennessee House of Representatives greeting each other on opening day of session. Jan. 9, 2023.(Photo: John Partipilo)

Tennessee state lawmakers in April 2022. (Photo: John Partipilo)

Editor’s note: This story has been updated to correctly identify Centene’s prison health care subsidiary.

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.

Next 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.

House Republicans push for delay of TennCare’s main contracts

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.

Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our web site. Please see our republishing guidelines for use of photos and graphics.

Adam Friedman
Adam Friedman

Adam Friedman is a reporter with the Tennessee Lookout. He has a particular love for data and using numbers to explain all kinds of topics. If you have a story idea, he'd love to hear it. Email him at [email protected] or call him at 615-249-8509.