UnitedHealth is under legal scrutiny as families of two deceased beneficiaries have filed a lawsuit, accusing the healthcare giant of knowingly employing a defective artificial intelligence algorithm to reject necessary extended care coverage for elderly patients.
The federal lawsuit, filed in Minnesota last Tuesday, contends that UnitedHealth unlawfully denied "care owed to elderly patients under Medicare Advantage Plans" by utilizing an AI model, identified by the company to have a 90% error rate. This allegedly resulted in overruling decisions made by patients' physicians, deeming the expenses as medically essential.
The complaint states, "The elderly are prematurely expelled from care facilities nationwide or compelled to deplete family savings to continue receiving necessary medical care, all because [UnitedHealth's] AI model 'disagrees' with their real live doctors' determinations."
Medicare Advantage plans, administered by private health insurers like UnitedHealth, offer elderly individuals an alternative to traditional federal health insurance plans, as per the U.S. Centers for Medicare and Medicaid Services.
The families claim that UnitedHealth's use of the purportedly flawed AI model, named "nH Predict" and developed by NaviHealth, allowed the insurance company to cease payments "prematurely and in bad faith," causing medical or financial hardships for elderly beneficiaries.
According to the lawsuit, UnitedHealth is accused of employing faulty AI as part of a financial strategy to collect premiums without having to cover elderly beneficiaries it believes lack the knowledge and resources "to appeal the erroneous AI-powered decisions."
The complaint asserts that UnitedHealth persists in "systemically denying claims using their flawed AI model" because they anticipate that only a small percentage of policyholders (around 0.2%) will appeal denied claims, with the majority either paying out-of-pocket costs or foregoing the remainder of their prescribed post-acute care.
The legal representatives for the families are seeking to represent all individuals who purchased Medicare Advantage Plan health insurance from UnitedHealth in the United States during the four years leading up to the filing of the complaint through the present.
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