Massachusetts Attorney General Andrea Campbell sued the insurer UnitedHealthcare Friday, charging that the company defrauded the state’s MassHealth program out of at least $100 million over the last decade.
Campbell said the lawsuit “sends a clear message that no company is above the law.” She called the allegations “egregious” and said the company must be held accountable.
But United, in a statement, called the suit “meritless” and said it does not accurately describe the senior care program at the center of the fraud claims.
“The Attorney General is simply wrong that Massachusetts seniors with complex care needs should not be receiving the support and services UnitedHealthcare is helping to provide,” the company’s statement said.
Many seniors are enrolled in a Senior Care Options plan that combines MassHealth and Medicare benefits. Campbell’s office said the UnitedHealthcare “falsely manipulated” the health status of MassHealth members enrolled in its SCO plan by making it look like they needed a higher level of care, so it could get more money from the state.
It allegedly told the state some members had behavioral health conditions like depression and anxiety, even though they did not have those diagnoses or related treatments. Similarly, the lawsuit alleges that the insurance company told MassHealth that some members needed daily skilled nursing services, when they did not need or receive that care.
Campbell said her office’s investigation “found that United encouraged staff to manipulate and misrepresent members’ health status to secure higher payments for MassHealth.”
“These were not isolated mistakes,” she told reporters. “These were knowing failures that our investigation found and frankly supported United’s strategy, which was to grow at all costs.”
United is Massachusetts’ largest provider of SCO plans, which serve eligible people age 65 and older who live in certain parts of the state.
The lawsuit comes as state lawmakers are deliberating over an annual budget that takes steps to rein in costs at MassHealth, the largest account in the state budget.
