Massachusetts sued UnitedHealthcare Insurance on May 29, 2026 in Suffolk County Superior Court in Boston, accusing it of defrauding MassHealth of more than $100 million by inflating patient risk scores through upcoding for patients 65 and older between 2015 and 2025. The lawsuit seeks to recoup overcharges and obtain triple damages. UnitedHealth called the lawsuit meritless.
Massachusetts Medicaid fraud lawsuit
- ▪The Massachusetts lawsuit against UnitedHealthcare was filed in the Suffolk County Superior Court in Boston on May 29, 2026
- ▪Andrea Joy Campbell, Massachusetts attorney general, accused UnitedHealthcare Insurance of manipulating the health status of MassHealth members enrolled in UnitedHealthcare Insurance's Senior Care Options plan in order to boost profit
- ▪Massachusetts sued UnitedHealthcare Insurance on May 29, 2026, accusing UnitedHealthcare Insurance of defrauding the state's Medicaid program, MassHealth, out of more than $100 million
- ▪The Massachusetts lawsuit against UnitedHealthcare seeks to recoup overcharges and obtain triple damages
- ▪The Massachusetts lawsuit against UnitedHealthcare accuses UnitedHealth of submitting false claims, breach of contract and unjust enrichment
Upcoding allegations
- ▪UnitedHealthcare allegedly overcharged MassHealth by $133,000 over five years for a patient who allegedly needed assistance with bathing, grooming and dressing but who actually demonstrated complete independence with help from Tylenol
- ▪Several former nurses reported that UnitedHealthcare encouraged upcoding, such as by diagnosing occasional headaches as migraines
- ▪UnitedHealthcare Insurance exaggerated diagnoses for patients 65 and older between 2015 and 2025 through a process known as upcoding
- ▪UnitedHealthcare Insurance failed to reimburse MassHealth for overcharges after internal reviews found that many patients had been improperly diagnosed
UnitedHealthcare response
- ▪UnitedHealth called the Massachusetts lawsuit meritless
- ▪UnitedHealth stated that the attorney general is wrong that Massachusetts seniors with complex care needs should not be receiving the support and services UnitedHealthcare is helping to provide
- ▪UnitedHealthcare operates in Massachusetts as UnitedHealthcare Community Plans of Massachusetts
Broader company context
- ▪UnitedHealth has sought to rebuild investor confidence after the December 2024 killing of UnitedHealthcare's chief executive prompted broad public criticism of health insurers' practices
- ▪UnitedHealth is based in Eden Prairie, Minnesota
- ▪UnitedHealth is the largest U.S. health insurer
- ▪UnitedHealthcare's chief executive was killed in December 2024
Perspective of UnitedHealth
- ▪UnitedHealth called the Massachusetts lawsuit meritless and stated that the attorney general is wrong about Massachusetts seniors with complex care needs not deserving support
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