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 2015 and 2025, Massachusetts Attorney General Andrea Joy Campbell stated in the complaint.
UnitedHealthcare, a subsidiary of UnitedHealth Group, said the complaint is “meritless and doesn’t accurately describe our Senior Care Options program” in a statement emailed to The Epoch Times.
The legal complaint alleged UnitedHealthcare inflated payment rates in three ways.
Upcoding
Massachusetts paid UnitedHealthcare a per-member, per-month rate for each senior enrolled in the plan based on UnitedHealthcare’s assessments of the member’s health conditions.
UnitedHealthcare allegedly labeled members as having behavioral health disorders such as depression or anxiety, or substance use disorders to gain higher reimbursement rates, according to the complaint, when the members had no diagnosis or treatment on record for such conditions.
An analysis by the attorney general’s office revealed that nearly 30 percent of UnitedHealthcare’s 2014 through 2024 behavioral health assessments lacked any matching medical claims to support the mental health diagnoses reported to the state.
Keeping Overpayments
The insurer’s internal reviews identified that many members were incorrectly placed in the highest and most expensive level of care despite not qualifying for it, according to the lawsuit.
While the company eventually downgraded these members to lower-paying levels, it allegedly failed to inform the state of the prior errors or return the extra money it had already collected.
Hellbound and Down 