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UnitedHealthcare's broken AI denied seniors' medical claims, lawsuit alleges

November 17, 2023
Contributed by: Bill Russell
Summary
UnitedHealthcare sued for allegedly denying healthcare claims based on unreliable AI model. Post-2020 Navihealth acquisition, insurer reportedly refused senior Medicare Advantage Plan users' claims, advised by flawed algorithm. Law firm alleges 90% error-rate AI overriding post-acute care recommendations for elders, contravening Medicare Advantage rules, favoring UnitedHealthcare financially. Alleged generic predictions, forbidding deviation from AI model; 'three-day stay hospital' patients reportedly receive denials after 14-day nursing home stays. 90% nH Predict AI model decisions reversed on appeal, demonstrating inaccuracies, lack of human review, and claims-communication opacity. UnitedHealthcare remained unresponsive.
The Register
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