UnitedHealthcare Accused of Using AI to Wrongfully Deny Medicare Advantage Claims, Here’s How It Works
UnitedHealthcare Accused of Using AI to Wrongfully Deny Medicare Advantage Claims, Here’s How It Works
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America has the most expensive healthcare and some of the worst outcomes in terms of longevity compared to European countries. I’m a teen with congenital heart issues and my dad has been fucked around by insurance and it’s so frustrating.
Anyway, deny defend depose.
If AI can make decisions about health claims, shouldn’t it also be accountable for the consequences? UnitedHealthcare seems to think otherwise.
A Senate subcommittee is accusing UnitedHealthcare of using AI to deny Medicare Advantage claims, particularly for post-acute care, such as skilled nursing services. A report revealed that denial rates jumped significantly from 2020 to 2022, coinciding with the company’s use of AI for faster claim processing. While UnitedHealthcare claims it follows Medicare rules, the AI system has been linked to more denials and errors, as it replaced some decisions previously made by doctors. This led to a class-action lawsuit alleging that the AI model, which is said to have a 90% error rate, wrongly denied care to elderly patients, with few appealing the decisions.
It’s kind of wild that you can pay money for a service, and that service can turn around and say no we aren’t providing you that service, we don’t want to.