UnitedHealthcare Sued Over Alleged Faulty AI Model in Medicare Claims Denial

Class Action Lawsuit Claims AI System with 90% Error Rate Overrides Physicians' Recommendations, Leading to Wrongful Denial of Healthcare Claims for Seniors

UnitedHealthcare is facing a class action lawsuit alleging the wrongful denial of healthcare claims for senior patients based on a faulty AI model, nH Predict.
The AI model, developed by NaviHealth, a company acquired by UnitedHealthcare in 2020, is accused of having a 90% error rate and overriding physicians' recommendations for post-acute care.
The lawsuit alleges that UnitedHealthcare instructed its employees not to deviate from the AI model's predictions and disciplined or terminated those who did so.
UnitedHealthcare's use of the AI model allegedly conflicts with Medicare Advantage coverage rules, leading to premature discontinuation of payment for healthcare services.
When patient claim denials are appealed, 90% of the AI model's determinations are reversed, indicating its inaccuracy.