Massachusetts Sues UnitedHealth Over Alleged Medicaid Upcoding Fraud
The Story
Massachusetts Attorney General Andrea Joy Campbell has filed a lawsuit against 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 receive inflated payments. The complaint states that UnitedHealthcare received at least $100 million more than it should have from the state’s Medicaid program due to fraudulent diagnoses, and that pressure to increase revenue led the company’s top Massachusetts executive to resign.
Key Facts
- Massachusetts Attorney General Andrea Joy Campbell is suing UnitedHealthcare, a subsidiary of UnitedHealth Group.
- The lawsuit alleges the company intentionally upcoded diagnoses for low-income older adults over the past decade.
- UnitedHealthcare received at least $100 million in inflated payments from Massachusetts Medicaid as a result, according to the complaint.
- Pressure to increase revenue and profit in the state’s Medicaid plan led the company’s top Massachusetts executive to quit.
- This lawsuit is among the first claiming fraudulent upcoding of Medicare patients who are also enrolled in a state Medicaid plan (dual eligibles).
- The allegations follow a series of investigations and reports on upcoding practices in Medicare Advantage.
Conflicting Reports
No conflicting reports identified in the source article.
Still Unclear
No open questions identified in the source article.
Misconceptions
No widespread misconceptions addressed in the source article.
Key Figures
- Andrea Joy Campbell, Massachusetts Attorney General.
- UnitedHealthcare, insurance subsidiary of UnitedHealth Group.
- Unnamed top Massachusetts executive of UnitedHealthcare, who resigned.
Sources: statnews.com
