Massachusetts sues UnitedHealthcare, claims $100 million overpayment

Bob covers the money in health care, focusing on health insurance and hospitals. His stories delve into Medicare Advantage, opaque prescription drug benefits, and how much executives actually make. He is also the author of the Health Care Inc. newsletter. You can reach Bob on Signal at bobjherman.09.

Massachusetts Attorney General Andrea Joy Campbell is suing UnitedHealth Group’s insurance subsidiary, UnitedHealthcare, alleging the company intentionally made low-income older adults appear sicker than they were over the past decade to boost its bottom line.

UnitedHealthcare received at least $100 million more than it should have from the Massachusetts Medicaid program due to inflated payments stemming from fraudulent diagnoses, Campbell alleges. Pressure to increase revenue and profit in the Medicaid plan in the state led the company’s top Massachusetts executive to quit, according to the complaint.

This lawsuit is among the first claiming fraudulent upcoding of Medicare patients who are also enrolled in a state Medicaid plan, but it follows a series of investigations and reports that have shined light on the practice in Medicare Advantage. The allegations in Massachusetts raise the prospect that UnitedHealth and other insurers have been using those same upcoding practices on “dual eligibles” — people who are enrolled in both Medicare and Medicaid — and therefore may command attention from state watchdogs.

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