Becker's Healthcare December 13, 2023
Humana used an artificial intelligence tool owned by UnitedHealth Group to wrongfully deny Medicare Advantage members’ medical claims, according to a class-action complaint filed Dec. 12.
The lawsuit was filed in the U.S. District Court for the Western District of Kentucky and is the latest legal action against major insurers such as UnitedHealthcare and Cigna for allegedly using automated data tools to wrongfully deny members’ claims.
The complaint against Humana, the country’s second-largest Medicare Advantage insurer, accuses the company of using an AI tool called nH Predict to determine how long a patient will need to remain in post-acute care and overrides physicians’ determinations for the patient. The plaintiffs claim Humana set a goal to keep post-acute facility stay lengths...
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