Becker's Healthcare May 22, 2024
UnitedHealth Group said a proposed class-action lawsuit alleging an AI algorithm wrongfully denied Medicare Advantage patients care should be dismissed because “plaintiffs have failed to exhaust the exclusive administrative appeal process set by the Medicare Act for challenging coverage determinations.”
“The Medicare Act, CMS regulations, and plaintiffs’ Medicare Advantage plans specify an exclusive administrative procedure that plaintiffs must complete before bringing their case to federal court,” UnitedHealth argued in a May 20 court filing. “None of the plaintiffs have completed Medicare’s administrative appeal process, and some have not appealed at all.”
The motion seeking dismissal is in response to a November lawsuit filed in Minnesota federal court alleging the company’s insurance arm — UnitedHealthcare — used an artificial intelligence-powered algorithm,...
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