UnitedHealth Group, Inc. (UNH.N) utilizes an AI algorithm that systematically rejects claims for extended care, such as nursing facility stays, for elderly patients, as alleged in a proposed class action lawsuit filed recently.
The lawsuit, filed by family members of two deceased UnitedHealth participants in Minnesota, accuses the company of forcing them to cover medical expenses that were recommended by doctors.
These plaintiffs seek to represent a broad spectrum of individuals enrolled in Medicare Advantage programs, which are administered by private insurers like UnitedHealth and funded by the U.S. Medicare program for the elderly and individuals with disabilities.
Ryan Clarkson, the founder of the law firm representing the plaintiffs, mentioned in an interview that the potential class could include tens of thousands of individuals, with damages possibly reaching billions of dollars.
UnitedHealth has not responded immediately to requests for comments. The company, operating through its UnitedHealthcare Inc subsidiary, is the largest health insurance provider in the United States.
The complaint targets the Minnesota-based business’s use of the nH Predict AI engine, developed by NaviHealth Inc., a company acquired by UnitedHealth in 2020. The lawsuit alleges that UnitedHealth employs this algorithm to assess claims for post-acute care, including services like in-home care and skilled nursing facility stays.
The lawsuit claims that UnitedHealth terminates healthcare service settlements prematurely and in bad faith using the nH Predict algorithm.
Clarkson highlights this case as an example of how AI technology can be misused to benefit corporations and shareholders at the expense of individuals in need.
The complaint reveals that approximately 90% of these coverage denials are overturned when challenged in national administrative law courts, exposing the algorithm’s significant inaccuracies. However, only a small fraction of patients actually contest these denials.
The lawsuit asserts that UnitedHealth’s use of the nH Identify algorithm violates various state insurance regulations and patient agreements by making claim decisions without thorough evaluations. The plaintiffs are seeking a court injunction to stop this practice and seek compensatory damages.
