Becker's Healthcare November 15, 2023
UnitedHealth Group and its health insurance arm, UnitedHealthcare, are facing a proposed class-action lawsuit alleging an AI algorithm wrongfully denied Medicare Advantage patients care.
The lawsuit was filed in federal court in Minnesota on Nov. 14 by the families of two deceased UnitedHealthcare Medicare Advantage members. The families alleges the two men were wrongfully denied coverage of medically necessary post-acute care by UnitedHealthcare. NaviHealth, the developer of the algorithm, is also named in the suit.
The plaintiffs allege UnitedHealthcare used an artificial intelligence-powered algorithm, nH Predict, to set coverage criteria for patients in post-acute care. The algorithm predicts how long a patient will need to remain in skilled nursing care, but overrides physicians’ determinations of what care a patient...
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