Maryland Sues Optum for $126M Medicaid Fraud Over Behavioral Health Claims System Failure
Maryland's Attorney General Anthony G. Brown has filed a lawsuit against Optum and UnitedHealth Group, alleging that they committed Medicaid fraud worth over $126 million.
The state alleges that Optum, which was awarded a contract to serve as the Administrative Services Organization (ASO) for Maryland's behavioral health Medicaid system in 2019, failed to operate the system properly from the start.
According to the complaint, Optum swapped its promised proprietary platform, OPTICCS, with an untested software called Incedo without MDH's approval. The switch caused a series of problems, including claims being rejected for no reason, providers unable to log in, and thousands of Medicaid recipients misidentified as uninsured.
The state paid Optum more than $126 million for a system that was never fully operational during the entire five-year contract term.