BOSTON — Massachusetts Attorney General Andrea Joy Campbell today filed a lawsuit in Suffolk Superior Court against UnitedHealthcare Insurance Company, d/b/a UnitedHealthcare Community Plans of Massachusetts, alleging the company falsely manipulated the health status of MassHealth members enrolled in its Senior Care Options plan to secure higher payments from the Commonwealth. The complaint estimates that the scheme defrauded MassHealth, the state’s Medicaid program, of at least $100 million.
“The state’s managed care plans need to act in good faith on behalf of their members and the financial resources of our state’s Medicaid program. Our investigation found that United Healthcare knowingly violated these obligations by manipulating health assessments to increase its profits,” said AG Campbell. “This lawsuit sends a clear message that no company is above the law, and my office will hold companies accountable for exploiting vulnerable residents and misusing taxpayer dollars.”
MassHealth’s SCO program serves eligible members age 65 or older living in designated service areas across Massachusetts. Enrollees must receive a comprehensive in-home clinical assessment to determine the member’s health status and assign them one of three levels of care, ranging from least serious and lowest payment rate (Level 1) to most serious and highest payment rate (Level 3). United is the largest provider of SCO plans in Massachusetts…