The lawsuit accuses UnitedHealthcare of using artificial intelligence to deny coverage to elderly patients.
The fatal shooting of UnitedHealthcare CEO Brian Thompson on Wednesday, which New York City police have described as „brazen“ and „targeted“, occurred after the insurance provider has faced legal scrutiny over its coverage.
Police have yet to make an arrest in the midtown Manhattan shooting, and a motive remains unclear. The shooting drew an array of reactions, with many critics not entirely sympathetic as they pointed out that the company has denied coverage to some patients. Others, however, slammed those reactions as insensitive, saying that a killing isn’t justified and that acts of violence should be denounced.
One criticism of UnitedHealthcare that has garnered attention following the shooting involves a lawsuit alleging the company uses artificial intelligence (AI) to deny coverage to some elderly patients who are on a Medicare Advantage plan, despite allegedly being aware that the algorithm has a 90 percent error rate.
The lawsuit was filed on November 14, 2023. It names UnitedHealth Group, UnitedHealthcare and NaviHealth as the defendants. It was brought by the families of two now-deceased patients who were denied coverage by UnitedHealthcare for stays at nursing homes. The suit is ongoing, and its claims have not been proved in court.What the UnitedHealthcare AI Lawsuit Alleges
The lawsuit alleges the provider continues using the system because it knows that only about 0.2 percent of policyholders will appeal their denied claims and that the majority will „either pay out-of-pocket costs or forgo the remainder of their prescribed post-acute care.“
The suit says that UnitedHealthcare banks „on the patients‘ impaired conditions, lack of knowledge, and lack of resources to appeal the erroneous AI-powered decisions.“
It goes on: „The fraudulent scheme affords Defendants a clear financial windfall in the form of policy premiums without having to pay for promised care, while the elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary medical care, all because an AI model ‚disagrees‘ with their real live doctors‘ determinations.
