So for years Centene used the specialty companies to help fund growth and profits. When I started for the Nurse Advice Line it was always weird how the pricing worked for internal and external business for the same work. Externally we would sell for less than $0.10 PMPM down to like .05 or so. Internally we were $1-2+ PMPM to the health plans. I began to wonder why but then looked at our C2C contributions to corporate we were required to give back like 50% of the money to Corp as profit. Further digging resulted in finding out the state contracts limit the amount of profit you can make on a Medicaid line of business at the plan level. But if a specialty company is involved they don't look at those and you get to charge it to the HBR of the plan because you are providing a service to the members. So for years CNC was using the specialty companies to pull more money from the states and keep more in profit than we should have been allowed. Over the years the states got wise and the margins had to be adjusted but I have not seen any of the states go back and ask for forensic accounting of what Centene did with the tax payers money.
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First, I don't think you understand what money laundering means.
Second, the nature of intercompany relationships and transaction amounts are disclosed in our stat statements. Copies of the agreements are also provided to our regulators for approval before the agreements commence. Our auditors also get copies of the agreements.
Hopefully you reported this outside of this forum.
Are you in accounting? The C2C model is outdated and hasn't been used for well over a year.
Billions in profit...and for what? Health Insurance is to largest legal racket known to humankind. When are Americans going to wake up? Think of how good healthCARE could be if we took out the billions in profit made by heath INSURANCE industry for Fu--ing us out of HealthCARE.
This sounds like what they did with Envolve Pharmacy and now they are paying the price. Was it worth it down the line though? My guess is probably because why else would they do it? Insurance is the most heavily regulated industry in the United States. They knew the fire pit they were playing in.
I would like to know why they can outsource to send tax dollars overseas to employ people in cheaper countries. Shouldn't federal and state tax dollars be used to employ people on American soil? That sounds like a loophole they take full advantage of.
Is that why they are repeatedly getting hit with major fines from several states?