Lawsuit alleges UnitedHealth used AI to wrongfully deny claims

Insurance giant UnitedHealth Group is facing a lawsuit alleging it used an artificial intelligence algorithm to wrongfully deny coverage to older patients for care under its Medicare Advantage health policies, Bloomberg Law reported Nov. 14.

The class action, filed by public interest law firm Clarkson Law Firm in the U.S. District Court for the District of Minnesota on Nov. 14, claims UnitedHealth made care determinations via its "nH Predict" algorithm, overriding physician recommendations and denied elderly patients' claims for treatment in extended care facilities. The suit alleges that UnitedHealth "[banks] on the patients' impaired conditions, lack of knowledge and lack of resources to appeal the erroneous AI-powered decisions."

A spokesperson for naviHealth, creator of the algorithm used by UnitedHealth, said in a statement to Bloomberg that its tool was not used for making coverage determinations.

Fellow payer Cigna was hit with a similar lawsuit in July that alleged it systematically rejects patient claims using an algorithm system it put in place to automate the process, spending an average of 1.2 seconds on each claim. The suit claimed the insurer does not have a "reasonable standard" for claims processing.

"[The algorithm used by Cigna] is a simple tool to accelerate physician payments that has been grossly mischaracterized in the press. The facts speak for themselves, and we will continue to set the record straight," a Cigna spokesperson told Forbes.

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