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UnitedHealthcare Defrauded MassHealth of $100M, AG Alleges
The state says UnitedHealthcare inflated member conditions and used false records to secure more than $100 million in improper MassHealth payments.
- On Friday, Massachusetts Attorney General Andrea Campbell sued UnitedHealthcare Insurance Company, alleging the insurer defrauded MassHealth of at least $100 million by manipulating health evaluations for the Senior Care Options program.
- The lawsuit claims UnitedHealthcare pursued a 'growth-at-all-costs' strategy, understaffing nurses and creating incentives to misclassify members into higher 'Level 3' categories to guarantee increased revenue from the state.
- Internal reviews revealed the insurer knew members did not meet criteria yet 'never disclosed' the issue to MassHealth, according to the complaint filed in Suffolk Superior Court.
- UnitedHealthcare spokesperson Eric Hausman called the lawsuit 'meritless,' arguing it 'doesn't accurately describe our Senior Care Options program,' and said the company remains focused on member care.
- The case raises concerns that upcoding practices involving 'dual eligibles'—people enrolled in both Medicare and Medicaid—may command attention from state watchdogs amid heightened federal focus on Medicaid fraud.
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Massachusetts Sues UnitedHealthcare Over Alleged $100 Million Fraud
Massachusetts sued UnitedHealthcare on May 29, alleging the company defrauded the state’s Medicaid program by making seniors appear sicker than they were to secure higher payments. The company contracted with MassHealth to provide a Senior Care Options—which combines Medicare and Medicaid benefits into one plan—for seniors aged 65 and older. UnitedHealthcare allegedly received more than $100 million in fraudulent payments from MassHealth between…
·New York, United States
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Coverage Details
Total News Sources15
Leaning Left4Leaning Right2Center5Last UpdatedBias Distribution46% Center
Bias Distribution
- 46% of the sources are Center
46% Center
L 36%
C 46%
R 18%
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