Massachusetts sues UnitedHealth over alleged Medicaid fraud targeting seniors

Massachusetts Attorney General Andrea Joy Campbell filed a lawsuit against UnitedHealth Group's UnitedHealthcare subsidiary, alleging the insurer deliberately over‑coded health conditions of low‑income seniors enrolled in the state’s Medicaid program.

The complaint says UnitedHealthcare inflated diagnoses to make beneficiaries appear sicker, resulting in at least $100 million in excess payments from the state Medicaid plan over the past decade.

The filing also notes that pressure to boost revenue led the company’s top Massachusetts executive to resign, highlighting internal concerns about the alleged practices.

This case is among the first to allege fraudulent upcoding of Medicare patients who are also covered by a state Medicaid plan, potentially setting a precedent for similar actions elsewhere.