A legal action has been initiated against UnitedHealth Group for allegedly denying older patients necessary treatment by utilizing an artificial intelligence algorithm.
The lawsuit, filed in the Minnesota district court on Tuesday, accuses UnitedHealth Group, United HealthCare, and NaviHealth of unlawfully employing the nH Predict AI model despite its reported 90% error rate. This algorithm purportedly replaced medical professionals, leading to the denial of essential care recommended by physicians under Medicare Advantage Plans.
The lawsuit further alleges that the defendants constrained their staff from deviating from the nH Predict recommendations, imposing strict usage targets under the threat of disciplinary measures or termination.
Reportedly, over 90% of individuals who challenged nH Predict’s denial of claims saw the decisions overturned. However, the plaintiffs argue that many policyholders either pay for care out of pocket or forego it entirely due to the AI model’s disagreements with medical professionals, ultimately benefiting the healthcare companies financially.
The defendants are accused of capitalizing on patients’ vulnerability, limited resources, and lack of awareness to challenge AI-driven decisions, potentially resulting in significant profits for the companies.
UnitedHealth Group, with more than 52.9 million users, stands as the largest healthcare provider in the United States. The lawsuit involves two clients, Gene Lokken and Dale Henry Tetzloff, both of whom are terminally ill and covered under a Medicare Advantage Plan that should include post-acute care.
The plaintiffs claim that they were forced to pay out of pocket for post-acute care recommended by their doctors, leading to the legal action seeking an injunction to halt these practices and address client grievances.
Lawyers representing the plaintiffs aim to gather tens of thousands of individuals with similar experiences, potentially resulting in substantial injury claims against the healthcare companies.
UnitedHealth has denied allegations that nH Predict influences policy decisions, as reported by HealthCare Drive.
