Post Date: December 18, 2023

The initial lawsuits alleges that Humana and UnitedHealthcare (UHC) uses AI algorithms to make decisions which results in denying seniors key rehabilitation care that was needed to render specific medical treatment. In other words, these healthcare insurance companies are accused of making medical coverage determinations based on AI tools outputs instead of on the actual individual patients' own needs. As a result, these algorithm outputs have bloomed into a vast increase of inappropriate post-care coverage denials of necessary care that was already prescribed by the patients’ doctors.

Another company to mention is Optum, a subsidiary of UnitedHealthcare (UHC), is facing similar charges; as patients have been denied long-care health coverage based on the decision-making algorithms tools. Human and UnitedHealthcare are two of the major players in the arena of Medicare Advantage market.

The plaintiffs of the lawsuits alleges that despite the high error rate of the AI algorithm output, UnitedHealthcare (UHC) continued to deploy the technology because a very small number of members, less than 1%, generally appeal denied coverage claims. The lawsuit further accuses the companies of banking on the patients’ impaired conditions, their lack of knowledge, as well as lack of resources to appeal the erroneous AI-powered decisions.

It has also been reported that Cigna has also been hit with multiple similiar lawsuits. There is no doubt we will probably see more and more similar lawsuits filed against other companies.

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