State prosecutors accuse UnitedHealthcare of $100M Medicaid fraud scheme

A lawsuit filed by state prosecutors last week accuses UnitedHealthcare of defrauding the state of Massachusetts of at least $100 million through a Medicaid fraud scheme.

The Massachusetts Attorney General’s Office filed the lawsuit against the health insurance giant on May 29 in Suffolk County Superior Court. The suit alleges that UnitedHealthcare intentionally misclassified seniors enrolled in MassHealth, the state’s Medicaid program, as needing higher levels of care to justify enrolling them in higher-cost coverage plans.

UnitedHealthcare fraudulently increased plan members’ need classifications through multiple methods, such as incorrectly assessing them as needing daily skilled nursing services, state prosecutors said in a press release. The health insurer also identified members as having mental health disorders despite them never having received such a diagnosis or associated treatment.

“The AGO alleges that these were intentional failures — the result of a ‘growth at all costs’ strategy employed by UnitedHealthcare that incentivized and encouraged its field nurses to code MassHealth members as sicker or less able than they were,” the attorney general’s office wrote in the release.

In 2018, UnitedHealthcare became aware that many MassHealth members at the highest-need classification level had been improperly classified, according to state prosecutors. The health insurer responded by downgrading the members’ classification level, but never informed MassHealth that it had overcharged for the members’ coverage plans.

“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. Our investigation found that UnitedHealthcare knowingly violated these obligations by manipulating health assessments to increase its profits,” Massachusetts Attorney General Andrea Campbell said in the release.

UnitedHealthcare did not respond to a request for comment on the lawsuit Tuesday afternoon.

©2026 Advance Local Media LLC. Visit masslive.com. Distributed by Tribune Content Agency, LLC.