Massachusetts Sues UnitedHealthcare for Medicaid Fraud

United States — Massachusetts State Police>>> Attorney General Andrea Campbell>>> has filed a lawsuit against UnitedHealth Group — UnitedHealth Group>>>, a subsidiary of UnitedHealth Group>>>, alleging that the insurer defrauded the state's Medicaid program, United States — Massachusetts health care reform>>>, of at least $100 million. The lawsuit claims that UnitedHealth Group — UnitedHealth Group>>> manipulated the health status of seniors enrolled in its Senior Care Options plans by 'upcoding' their conditions to higher, more expensive tiers, even when they did not qualify for such services. Specific allegations include classifying patients as 'Level 2' for behavioral health conditions without diagnosis, improperly assessing members as 'Level 3' for serious chronic needs, and billing for daily skilled nursing services that were neither needed nor received. The state asserts that UnitedHealth Group — UnitedHealth Group>>> was aware of these improper classifications through internal reviews but failed to inform United States — Massachusetts health care reform>>> or repay the overpayments. UnitedHealth Group — UnitedHealth Group>>> has dismissed the complaint as meritless, stating that it accurately describes their program which helps seniors with complex care needs. This legal action follows a Senate investigation and a United States — United States Department of Justice>>> inquiry into UnitedHealth Group>>>'s Medicare coding practices, highlighting broader concerns about the company's conduct in government health programs.