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Massachusetts Sues UnitedHealthcare Over Alleged $100 Million Fraud

Authored by Sylvia Xu via The Epoch Times,

Massachusetts sued UnitedHealthcare on May 29, alleging the company defrauded the state’s Medicaid program by making seniors appear sicker than they were to secure higher payments.

The company contracted with MassHealth to provide a Senior Care Options—which combines Medicare and Medicaid benefits into one plan—for seniors aged 65 and older.

UnitedHealthcare allegedly received more than $100 million in fraudulent payments from MassHealth between 2015 and 2025, Massachusetts Attorney General Andrea Joy Campbell stated in the complaint.

UnitedHealthcare, a subsidiary of UnitedHealth Group, said the complaint is “meritless and doesn’t accurately describe our Senior Care Options program” in ‌a statement emailed to The Epoch Times.

The legal complaint alleged UnitedHealthcare inflated payment rates in three ways.

Upcoding

Massachusetts paid UnitedHealthcare a per-member, per-month rate for each senior enrolled in the plan based on UnitedHealthcare’s assessments of the member’s health conditions.

UnitedHealthcare allegedly labeled members as having behavioral health disorders such as depression or anxiety, or substance use disorders to gain higher reimbursement rates, according to the complaint, when the members had no diagnosis or treatment on record for such conditions.

An analysis by the attorney general’s office revealed that nearly 30 percent of UnitedHealthcare’s 2014 through 2024 behavioral health assessments lacked any matching medical claims to support the mental health diagnoses reported to the state.

Keeping Overpayments

The insurer’s internal reviews identified that many members were incorrectly placed in the highest and most expensive level of care despite not qualifying for it, according to the lawsuit.

While the company eventually downgraded these members to lower-paying levels, it allegedly failed to inform the state of the prior errors or return the extra money it had already collected.

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Unneeded or Nonexistent Nursing Services

The insurer was paid $1.4 billion for members who did not qualify for the most expensive status, but the insurer justified the rate by submitting assessments claiming members required daily or frequent skilled nursing care, the complaint alleged.

However, an investigation revealed that most of these members neither received nor actually needed the specialized nursing services, according to the complaint.

Out of more than 88,000 assessments for the highest payment level, UnitedHealthcare asserted that 99.3 percent of those members were receiving nursing visits seven days a week. However, the complaint alleged that almost 90 percent of those members had not received a single nursing visit in the week before UnitedHealthcare filed the assessment.

Arguments

A January Senate report accused UnitedHealth Group of using high-tech scanners and a team of specialists to capture profitable, extra diagnoses in beneficiaries to maximize federal payments from the Medicare Advantage program.

The corporation issued a statement that same day, citing studies that it had commissioned to argue that Medicare Advantage saves money for both the government and beneficiaries.

The Attorney General’s Office alleged that these were intentional failures, the result of a “growth at all costs” strategy employed by UnitedHealthcare that incentivized and encouraged field nurses to code MassHealth members as sicker or less able than they were.

Bernadette Di Re, the CEO of UnitedHealthcare’s plan in Massachusetts from 2011 through 2020, allegedly attributed pressure to “cut staff,” “[g]et more numbers,” and “[g]et more money from the state” as the reason she resigned and left the company, the lawsuit stated.

“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 UnitedHealthcare knowingly violated these obligations by manipulating health assessments to increase its profits,” said Campbell in a statement.

The company responded in a statement: “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. We remain focused on working with our state partner to help our members live healthier lives.”

Tyler Durden Mon, 06/01/2026 - 17:00

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The Latest Graham Platner Scandal Could Be His Undoing

Graham Platner built his Senate campaign on a carefully curated image: the decorated veteran, the Maine oyster farmer, the working-class progressive who talks straight and fights for the little guy.

Despite a slew of scandals, including a Nazi-linked tattoo and many extremely problematic Reddit posts, Maine Democrats handed him the keys to one of their most coveted 2026 targets: the Senate seat held by incumbent Republican Sen. Susan Collins. 

Gov. Janet Mills, who ran against Platner in the Democratic primary, launched attack ads targeting his Reddit comments before suspending her campaign ahead of the June 9 primary and clearing the field for him. That left Platner as the consensus Democratic standard-bearer in a race the party views as essential to reclaiming the Senate majority. 

Now, a cascade of new revelations about his past is forcing an uncomfortable reckoning for the Democratic Party, as some Democrats are now asking, in public and in private, whether the party rushed to embrace a candidate who was never fully vetted.

A new report from the Wall Street Journal revealed that days after Platner formally announced his Maine Senate bid last year, his wife, Amy Gertner, quietly pulled a campaign aide aside to disclose that she had previously discovered sexually explicit text messages between her husband and multiple women on a private messaging app called Kik. She had found them in the spring of 2025, early in their marriage. She raised them again with campaign staff in late August as part of the campaign’s internal opposition research on him, out of concern that the messages could blindside the operation as momentum was building.

Campaign aides weighed the disclosure, then decided the texts were a private marital matter. In a statement released through the campaign, Gertner framed the episode as a test the marriage passed. "We did the hard work that marriage requires. We went to counseling. We were honest with each other in ways that weren't easy," she said. "And we came through it, not in spite of how much we've been through, but because of how much we love each other and the life we've built. Our marriage today is stronger than ever before." 

However, the text messages are more problematic than just a mere marital issue, because the platform itself carries serious baggage. Anti-exploitation groups have described Kik as a haven for online predators.

The app has appeared in multiple prosecutions in Maine alone in recent years, and the Center on Sexual Exploitation called it a "predator's paradise" and warned that it has a "huge child exploitation problem."

One law enforcement professional told The Maine Wire, "only pedos use Kik." 

Following these latest allegations, we learned on Sunday that Platner’s campaign manager, Morris Katz, attempted to prevent Genevieve McDonald from publicly discussing information she had about Platner’s alleged infidelities.

From @bangordailynews, Platner’s campaign manager Morris Katz tried to stop Genevieve McDonald from sharing information about Platner’s infidelities (which he had since the beginning of the campaign) with threats of defaming her. pic.twitter.com/LTUbROD0Ja

— Shannon Watts (@shannonrwatts) May 31, 2026

 According to McDonald, the campaign offered her $15,000 to sign a nondisclosure agreement, which she refused. She claims that after declining the offer, the campaign worked to discredit her through local media outlets. 

That story. Genevieve McDonald said the campaign offered to pay her $15,000 to sign an NDA. She declined. Platner's campaign then smeared her in local outlets https://t.co/lMk8ryylqk pic.twitter.com/Al5VisaOC9

— Chuck Ross (@ChuckRossDC) May 31, 2026

McDonald also shared a message from Katz warning that if the story became public, the campaign would state “on the record, and by name” that she had “violated the personal trust of Amy and Graham” and spread “explicit falsehoods to sabotage the campaign.”

Platner campaign advisor Morris Katz to Genevieve McDonald: “If the story goes in its current iteration, we’ll communicate directly on the record, and by name, that Genevieve violated the personal trust of Amy and Graham and shared explicit falsehoods to sabotage the campaign.” pic.twitter.com/O1F1FlBOZz

— Jerry Dunleavy IV 🇺🇸 (@JerryDunleavy) May 31, 2026

Platner’s use of the app comes on top of a growing pile of damaging information that has been accumulating for weeks, but the sexting revelations and the NDA threats are structurally different from every prior scandal: they don’t just describe a flawed man; they describe an active cover-up by his own campaign.

Every scandal that surfaces makes the carefully curated version of Graham Platner harder to believe, and harder to see how his campaign can survive.

Tyler Durden Mon, 06/01/2026 - 16:40