An investigation into a flawed artificial intelligence-based algorithm has triggered a class action lawsuit against UnitedHealth Group, the leading provider of the country’s largest Medicare Advantage plan. This case highlights the enduring impact of traditional reporting methods in today’s digital age.
The lawsuit alleges that UnitedHealth utilized a system with a documented history of high failure rates to deny costly treatment to critically ill patients. This accusation arose following several investigative pieces by STAT. Despite UnitedHealth’s assertion that the lawsuit lacks merit, a Senate hearing was convened in response to a series of reports by Rating and ongoing analyses by ProPublica. These investigations shed light on insurer practices that allegedly circumvented state laws mandating coverage for fertility or cancer treatments.
Simultaneously, a collaborative series titled “Dying Broke” by New York Times and KFF Health News delves into the financial and emotional burdens of providing and financing long-term care. The Washington Post has also initiated an exploration into the intersection of politics, anxiety, and chronic illness, addressing the question of why many Americans face premature deaths.
Amidst the proliferation of fragmented data solutions and constrained media budgets, the integrity of traditional journalism endures. STAT reporters Casey Ross and Bob Herman, investigating the reported misuse of algorithms, recently shared their insights on a broadcast overseen by their editor, Lison Joseph. This reaffirms the enduring relevance of fundamental journalistic principles, transcending technological advancements.
Commencing an Investigation
Investigative journalists like Ross and Herman are critical in uncovering systemic issues. When approached by a post-acute care provider regarding coverage decisions, the reporters initially approached the matter with caution, considering the industries’ histories tainted by financial incentives. However, the distress expressed by a physician over the impact of AI algorithms on care decisions piqued their interest. Concurrently, the Centers for Medicare & Medicaid Services solicited feedback on Medicare Advantage programs, revealing widespread discontent among stakeholders.
The subsequent story, titled “Denied by AI: How Medicare Advantage plans use systems to minimize care for elders in need,” exposed the case of an elderly woman in Wisconsin subjected to inadequate care based on an algorithm’s flawed assessment. This narrative catalyzed a cascade of complaints from case managers and reviewers at NaviHealth, illustrating the detrimental impact of performance targets tied to algorithmic recommendations.
As the investigation progressed, the focus shifted to the broader implications of corporate control over unregulated AI tools, exemplified by UnitedHealth’s acquisition of NaviHealth. Despite UnitedHealth’s rebranding efforts following public scrutiny, ongoing investigative reports underscored the ethical dilemmas posed by AI-driven decision-making in healthcare.
Uncovering Systemic Issues
Investigative journalism has historically served as a potent tool in exposing healthcare malpractices, from historical injustices to contemporary challenges like exorbitant medical bills and unethical treatment practices. While investigative efforts aim to drive accountability and reform, the ultimate impact on policy change remains uncertain.
The complexity of healthcare systems necessitates a nuanced understanding of the factors contributing to systemic issues. Transparent reporting on AI in healthcare, as pursued by journalists like Ross, holds the potential to catalyze meaningful dialogue and reform in the evolving landscape of AI-driven decision-making.
As society navigates an increasingly AI-dependent future, investigative journalism remains vital in scrutinizing the ethical implications of machine-driven decisions alongside human judgment.
