Medical Economics November 16, 2023
Lawsuit charges company ended rehabilitation care payments based on algorithm with high error rate
UnitedHealthcare, Inc. and its subsidiary NaviHealth, Inc. have been hit with a class action lawsuit charging that they illegally use an artificial intelligence (AI) algorithm to deny rehabilitation care claims of elderly patients with Medicare Advantage plans, despite knowing the algorithm has a high error rate.
The class action complaint, filed November 14 in U.S. District Court in Minnesota, alleges that the algorithm, known as “nH Predict,” uses “rigid and unrealistic predictions for recovery” to determine coverage criteria for Medicare Advantage patients in post-acute care settings. It charges that despite having a 90% error rate UnitedHealthcare employs the algorithm because it knows that only about .2%...
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