Centene Examined, Part 1

Introduction and Overview

“Centene Examined” is a series of posts based on a whistleblower complaint submitted to the U.S. Securities and Exchange Commission on November 5, 2022, concerning Centene Corporation, a publicly traded company (stock symbol: CNC).

In 2022, Centene had more than $144 billion in revenue in 2022, of which more than $93 billion came from Medicaid and its related programs. Medicaid is the largest of Centene’s three primary business lines. The other two are Medicare ($22+ billion in revenue) and Commercial Insurance ($17+ billion in revenue).

Centene provides Medicaid services to more than 15.9 million enrollees in 30 states through wholly owned subsidiaries of the company. Measured by number of enrollees, Centene is the largest provider of Medicaid services in the U.S.

The managed care contracts between state Medicaid agencies and Centene are relatively straightforward. Centene (or, more accurately, its subsidiaries) commit to providing a basket of services to enrollees in a state Medicaid plan. In return, the state Medicaid agencies makes fixed payments to Centene on a per person per month basis.

Centene does not provide health care services directly to its Medicaid plan enrollees. Centene contracts with hospitals, hospital systems, and health care providers to provide necessary and appropriate health care related services to plan enrollees.