Overview

• 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.