Maryland Attorney General Anthony Brown has filed a lawsuit against UnitedHealth Group, alleging that its Optum unit defrauded the state's Medicaid program by providing a faulty computer system.
In the lawsuit, Brown's office claims that the system, which was implemented in the state's Medicaid behavioral health program, crashed on its first day in use and ultimately "never functioned properly." The company's contract with the state ran from 2019 to 2024, with the state paying $126.9 million for Optum to manage its Administrative Services Organization program.
The lawsuit also says that the system crash was so severe that the program was forced to take it offline in 2020 for eight months, which put access to its services in jeopardy for 1.5 million Medicaid enrollees. The issues with the system cost Maryland "tens of millions of dollars," the AG's office said.
"Marylanders in crisis and the providers who care for them rely on Maryland’s Medicaid program for essential mental health and substance abuse care," Brown said in a press release. Optum provided a defective system that failed them for years."
The lawsuit claims that in the final months before the system was rolled out, Optum switched its own proprietary claims management system for one built by a subcontractor. Brown's office alleges that this system was "inadequately tested" and "inadequately vetted."
Because the system did not work as intended, it denied legitimate claims for care, made incorrect payments to providers and failed to identify "rampant, multi-million-dollar fraud."
The state is seeking triple the value of the contract—about $380 million—in damages for the alleged violations of Maryland's False Claims Act. The lawsuit also alleges breach of contract and intentional misrepresentation.
An Optum spokesperson said the company "vehemently disagrees" with the claims in the lawsuit. The spokesperson also emphasized that the contract was directly between Optum and the state, and does not relate to UnitedHealthcare's Medicaid business in Maryland.
"Optum vehemently disagrees with the Maryland Attorney General's lawsuit, which fails to account for the complexities of the program’s implementation and overlooks our sizeable commitment and investment to provide a high standard of compliant services for the State," the spokesperson said.