- Massachusetts AG Andrea Joy Campbell sued UnitedHealthcare Insurance Company, d/b/a UnitedHealthcare Community Plans of Massachusetts, asserting Massachusetts False Claims Act, unjust enrichment, and breach of contract claims over allegations that the insurer inflated health-status assessments for seniors enrolled in its MassHealth Senior Care Options plan.
- According to the complaint, UnitedHealthcare improperly moved members into higher-paying care levels by reporting unsupported behavioral health diagnoses, kept members at the highest care level after internal reviews showed they did not qualify, and claimed members needed skilled nursing services they did not receive.
- The complaint also alleges UnitedHealthcare knew its assessment process was producing inaccurate results but continued submitting the assessments to MassHealth, citing nurse understaffing, copied-and-pasted assessments, and reduced quality-control reviews despite known documentation issues.
- Massachusetts seeks to recover more than $100 million in alleged overpayments, along with treble damages, civil penalties, and other relief.