HealthExec November 16, 2023
UnitedHealth Group, the largest U.S. health insurance provider, is facing a potential class action lawsuit alleging its use of an artificial intelligence (AI) algorithm systematically denied elderly patients’ claims for extended care.
The focal point of the lawsuit is an AI algorithm called nH Predict, developed by NaviHealth, a company acquired by UnitedHealth in 2020. The algorithm is purportedly used by the insurer to assess claims for post-acute care, including stays in skilled nursing facilities and in-home care.
According to the complaint, UnitedHealth used the algorithm to prematurely and in bad faith discontinue payment for healthcare services. When these denials are appealed to federal administrative law judges, approximately 90% are reversed, highlighting the alleged blatant inaccuracy of the...
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