Massachusetts Attorney General Andrea Joy Campbell filed a lawsuit in May 2026 against UnitedHealthcare, accusing the company of defrauding the state’s Medicaid program (MassHealth) of at least $100 million.
The Core Allegations:
- Upcoding Health Statuses: The lawsuit alleges UnitedHealth intentionally manipulated and misrepresented the health statuses of vulnerable, low-income seniors enrolled in its Senior Care Options (SCO) program between 2015 and 2025.
- Fictitious Diagnoses: UnitedHealth is accused of falsely assigning severe behavioral health or anxiety diagnoses to patients to inflate their health risk scores, allowing the company to pocket significantly higher reimbursements.
- Inadequate Care: The complaint claims the company pushed a “growth-at-all-costs” strategy, inadequately staffed assessment teams, and submitted claims for 7-day nursing visits that never happened.
The Repercussions:
- Damages Sought: Massachusetts is demanding the return of the $100 million in alleged overpayments. Under federal and state False Claims Acts, this amount could be tripled, opening UnitedHealth to $300 million in damages plus litigation costs.
- UnitedHealth’s Response: UnitedHealth has publicly denied the claims, stating that the complaint is “meritless” and misrepresents a program designed to help seniors with complex needs.
For a detailed breakdown of the complaint and further updates, check the official Massachusetts Attorney General Press Release.
