Massachusetts has filed a lawsuit against UnitedHealthcare, accusing the insurer of retaining more than $100 million in fraudulent Medicaid payments.
The May 29 complaint, filed in a state court, focuses on UnitedHealthcare’s role as a contractor for “Senior Care Options,” a state program for dual-eligible Medicare and Medicaid beneficiaries. Some allegations date back to more than 10 years ago.
From 2014 through 2025, UnitedHealthcare received more than $5 billion in payments for its SCO plan. A state investigation found that UnitedHealthcare’s member assessments were spun to get higher payments.
The complaint alleges that UnitedHealthcare listed incorrect behavioral health diagnoses, claimed members needed the highest level of care when they did not and trained staff to always log seven days of visiting nursing services for the highest-acuity members. In 2018 and 2019, amid audits, UnitedHealthcare submitted revised assessments for nursing home certifiable classifications, but the insurer did not clarify the downgrades or pay back the overpayments, the lawsuit said.
Massachusetts is accusing the insurer of using false claims and records, as well as concealing and failing to return overpayments, illegally keeping funds and violating contracts. The state is seeking civil penalties of up to $11,000 per violation, triple the actual damages, interest and costs.
“The state’s managed care plans need to act in good faith on behalf of their members and the financial resources of our state’s Medicaid program,” Massachusetts Attorney General Andrea Campbell said in a May 29 news release. “Our investigation found that UnitedHealthcare knowingly violated these obligations by manipulating health assessments to increase its profits.”
Becker’s has contacted UnitedHealthcare for comment and will update this story if more information becomes available.
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