STAT May 22, 2024
Bob Herman, Casey Ross

UnitedHealth Group should be released from a lawsuit that alleges its algorithm-based technology prematurely cut off care to its Medicare Advantage members, the company said in court filings this week, because patients and their families did not finish Medicare’s appeals process.

“Plaintiffs have failed to exhaust the exclusive administrative appeal process set by the Medicare Act,” UnitedHealth’s lawyers argued. Even if those requirements were met, they added, the grievances of patients and families are with the federal government, not UnitedHealth and its subsidiary NaviHealth. “The plaintiffs have sued the wrong defendants,” the filing states.

Medicare’s appeals process is backlogged and complicated. Completing it can take years in some instances, potentially draining the finances of Medicare beneficiaries and their families who...

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Topics: CMS, Govt Agencies, Insurance, Medicare Advantage, Patient / Consumer, Payer, Provider
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