Skilled Nursing News November 15, 2023
UnitedHealthcare, a unit of UnitedHealth Group (NYSE: UNH), is facing a federal lawsuit over its use of an artificial intelligence tool in making Medicare Advantage claims denials for patients in extended care facilities.
That same issue was at the center of a recently published piece in STAT, a health-oriented news outlet.
Aaron Albright, a spokesperson for Optum, the unit of UnitedHealth involved in the lawsuit’s claims, told Skilled Nursing News that the AI tool used in assessing claims is more for guidance and not for denial of insurance claims.
“The [NaviHealth] predict tool is not used to make coverage determinations. The tool is used as a guide to help us inform providers, families and other caregivers about what sort of...
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