McKnight’s Senior Living November 17, 2023
Kimberly Marselas

The nation’s largest insurer is illegally using programs driven by artificial intelligence to override the decisions of medical professionals and wrongfully force residents from nursing homes, a lawsuit seeking class-action status claims.

A lawyer representing the plaintiffs told Reuters that the class, if certified by the court, could include tens of thousands of plaintiffs, and that claims for damages could reach billions of dollars.

The case is being brought by the estates of Gene B. Lokken and Dale Henry Tetzloff, both Medicare Advantage beneficiaries whose coverage for skilled nursing care abruptly was cut off just days into their stays. Doctors overseeing their treatment insisted that they needed further in-patient services, but both cases were denied on appeal. Each family paid...

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Topics: AI (Artificial Intelligence), Insurance, Medicare Advantage, Post-Acute Care, Provider, Technology
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