Fierce Healthcare November 15, 2023
UnitedHealthcare is facing a potential class-action lawsuit following allegations that it used an algorithm to deny claims for post-acute care services in Medicare Advantage (MA).
The proposed class action was filed Monday by the families of two deceased MA members, who argue that the insurer “illegally” deployed the naviHealth platform to deny medically necessary care to seniors. The lawsuit said the technology has a “90% error rate.”
The plaintiffs allege that despite that high error rate, UnitedHealth continued to deploy the technology because a very small number of members, less than 1%, generally appeal denied claims.
“Defendants bank on the patients’ impaired conditions, lack of knowledge, and lack of resources to appeal the erroneous AI-powered decisions,” they said in the...
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