Massachusetts AG Sues UnitedHealthcare for $100M Medicaid Fraud
Massachusetts AG sues UnitedHealthcare for $100M Medicaid fraud through inflated risk scores.
Why it matters: This case reveals alleged systematic fraud impacting MassHealth payments and highlights legal risks for insurers manipulating patient data. Legal and compliance teams must watch for enforcement trends in Medicaid fraud.
- Lawsuit filed May 29, 2026, by Massachusetts AG Andrea Joy Campbell against UnitedHealthcare.
- Alleges insurer inflated health risk scores in Senior Care Options plan, defrauding MassHealth of at least $100 million.
- UnitedHealthcare reportedly upcoded members to higher care levels without proper diagnoses or treatments.
- Company denies allegations, calling them meritless and inaccurate.
- UnitedHealthcare serves about 25,000 SCO plan enrollees in Massachusetts.
On May 29, 2026, Massachusetts Attorney General Andrea Joy Campbell filed a lawsuit accusing UnitedHealthcare Insurance Company of defrauding MassHealth by at least $100 million. The suit alleges that UnitedHealthcare manipulated health assessments for members in its Senior Care Options (SCO) plan, the state's Medicaid program serving seniors aged 65 or older.
Specifically, UnitedHealthcare is accused of classifying SCO members as Level 2—indicating behavioral health or substance use disorders—even when such diagnoses or treatments were absent. The insurer also allegedly assessed members as Level 3, reserved for the most serious conditions, despite internal reviews in 2018 and 2019 exposing misclassifications. These errors were not disclosed to MassHealth, nor were the resulting overpayments repaid.
Additionally, the complaint states the insurer submitted assessments claiming members required daily skilled nursing services, although most did not receive such care, inflating payments from the state. According to the Attorney General's Office, this was part of a "growth at all costs" strategy incentivizing field nurses to code members as sicker than they were to boost profits.
UnitedHealthcare is the largest SCO plan provider in Massachusetts, with approximately 25,000 enrollees. The SCO program provides comprehensive clinical assessments to determine health status and assign one of three care levels, impacting payment rates.
AG Campbell said, "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 United Healthcare knowingly violated these obligations by manipulating health assessments to increase its profits."
UnitedHealthcare spokesperson Eric Hausman responded: "The Massachusetts Attorney General's complaint is meritless and doesn't accurately describe our Senior Care Options program, which helps seniors with complex care meet their individual health needs."
This lawsuit highlights the ongoing challenges of regulatory compliance in Medicaid managed care and the repercussions for insurers implicated in fraudulent payment schemes.
By the numbers:
- $100 million — alleged overpayments by MassHealth to UnitedHealthcare.
- 25,000 — number of SCO plan members served by UnitedHealthcare in Massachusetts.
- May 29, 2026 — date when the Massachusetts AG filed the lawsuit.
Yes, but: UnitedHealthcare denies the allegations, maintaining its Senior Care Options program supports seniors' health needs and describing the complaint as meritless.