UnitedHealth sued over use of algorithm to deny care for MA members

Healthcare DIVE November 15, 2023
Rebecca Pifer

The lawsuit alleges UnitedHealth used nH Predict to deny claims for Medicare Advantage seniors, despite the algorithm’s determinations being overturned in more than 90% of appeals.

Dive Brief:

• UnitedHealth is being sued over allegations that it used an algorithm to deny rehabilitation care for Medicare Advantage beneficiaries, despite knowing the algorithm’s high error rate.
• The lawsuit, filed Tuesday in a Minnesota district court, cites a recent investigation by Stat News finding UnitedHealthcare, the largest MA payer in the U.S., pressured employees to use the algorithm to predict patients’ length of stay, and deny payment if their rehab care extended beyond that date.
• UnitedHealth denies using nH Predict for coverage determinations. “Coverage decisions are based on CMS coverage criteria and...

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