Lawsuit Alleges UnitedHealth Artificial Intelligence (AI) System Wrongfully Denies Elderly Patients’ Claims, Seeking Billions in Damages
A proposed class action lawsuit has been filed against UnitedHealth Group Inc., alleging that the company’s artificial intelligence (AI) algorithm systematically denies claims for extended care made by elderly patients. Family members of two former UnitedHealth beneficiaries have taken legal action, claiming they were forced to pay out of pocket for care that their doctors deemed medically necessary. The lawsuit aims to represent a nationwide class of individuals on Medicare Advantage insurance plans, which are funded by the US Medicare program and administered by private health insurers like UnitedHealth.
The founder of the law firm representing the plaintiffs, Ryan Clarkson, has stated that the class could potentially include tens of thousands of people, with potential damages reaching billions of dollars. While UnitedHealth has not yet responded to the allegations, it is important to note that the company is the largest health insurance provider in the United States through its subsidiary, UnitedHealthcare Inc.
The lawsuit revolves around an AI algorithm called nH Predict developed by NaviHealth Inc, a company that UnitedHealth acquired in 2020. The complaint argues that UnitedHealth relies on nH Predict to evaluate claims for post-acute care, which includes stays in skilled nursing facilities and in-home care. The plaintiffs allege that UnitedHealth utilizes the algorithm to prematurely and dishonestly discontinue payment for healthcare services.
According to Clarkson, this case signifies a prime example of how AI is being used not to benefit individuals but rather to benefit corporations and shareholders. The complaint also highlights that when coverage denials like these are appealed to federal administrative law judges, approximately 90% of them are reversed, effectively demonstrating the algorithm’s blatant inaccuracy. Clarkson notes that only a small fraction of patients even appeal these denials.
The lawsuit contends that UnitedHealth’s use of the nH Predict algorithm violates patient contracts and insurance laws in various states, as it allegedly makes claim decisions without conducting proper evaluations. The plaintiffs are seeking a court order to halt this practice and are also seeking monetary damages.
In conclusion, the lawsuit against UnitedHealth Group Inc. raises significant concerns about the AI algorithm the company employs to evaluate claims for post-acute care. The plaintiffs argue that this algorithm wrongfully denies elderly patients’ claims for extended care, causing financial burden and potentially compromising their health. As the case moves forward, it will be crucial to assess the validity of these allegations and consider the impact of AI systems on healthcare services, ensuring that the well-being of patients remains a top priority.
