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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsFrom 2023: UnitedHealth uses AI model with 90% error rate to deny care, lawsuit alleges
For the largest health insurer in the US, AI's error rate is like a feature, not a bug.
UnitedHealthcare, the largest health insurance company in the US, is allegedly using a deeply flawed AI algorithm to override doctors' judgments and wrongfully deny critical health coverage to elderly patients. This has resulted in patients being kicked out of rehabilitation programs and care facilities far too early, forcing them to drain their life savings to obtain needed care that should be covered under their government-funded Medicare Advantage Plan.
That's all according to a lawsuit filed this week in the US District Court for the District of Minnesota. The lawsuit is brought by the estates of two deceased people who were denied health coverage by UnitedHealth. The suit also seeks class-action status for similarly situated people, of which there may be tens of thousands across the country.
The lawsuit lands alongside an investigation by Stat News that largely backs the lawsuit's claims. The investigation's findings stem from internal documents and communications the outlet obtained, as well as interviews with former employees of NaviHealth, the UnitedHealth subsidiary that developed the AI algorithm called nH Predict.
"By the end of my time at NaviHealth I realized: I'm not an advocate, I'm just a moneymaker for this company," Amber Lynch, an occupational therapist and former NaviHealth case manager, told Stat. "It's all about money and data points," she added. 'It takes the dignity out of the patient, and I hated that."
That's all according to a lawsuit filed this week in the US District Court for the District of Minnesota. The lawsuit is brought by the estates of two deceased people who were denied health coverage by UnitedHealth. The suit also seeks class-action status for similarly situated people, of which there may be tens of thousands across the country.
The lawsuit lands alongside an investigation by Stat News that largely backs the lawsuit's claims. The investigation's findings stem from internal documents and communications the outlet obtained, as well as interviews with former employees of NaviHealth, the UnitedHealth subsidiary that developed the AI algorithm called nH Predict.
"By the end of my time at NaviHealth I realized: I'm not an advocate, I'm just a moneymaker for this company," Amber Lynch, an occupational therapist and former NaviHealth case manager, told Stat. "It's all about money and data points," she added. 'It takes the dignity out of the patient, and I hated that."
https://arstechnica.com/health/2023/11/ai-with-90-error-rate-forces-elderly-out-of-rehab-nursing-homes-suit-claims/
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From 2023: UnitedHealth uses AI model with 90% error rate to deny care, lawsuit alleges (Original Post)
tenderfoot
Dec 4
OP
gay texan
(2,940 posts)1. Hence
Why i refuse to play nice
LetMyPeopleVote
(158,091 posts)2. This is a very high claim denial rate
Silent Type
(8,253 posts)3. That's the initial denial rate. Most -- like 80+ % -- get overturned on appeal. We have to figure out a better way of
handling this.
Insurers definitely deny services that are needed. But, doctors do order tests, procedures, treatments, etc., that are not warranted.
The real guardrail to this -- absent laws that say services can't be denied -- is suing insurance companies. Lawyers love those cases when the evidence is that the denial was the cause or contributed to bad outcomes.
Joinfortmill
(17,194 posts)4. This shooting is going to open up a very ugly can of worms.