UnitedHealthcare (UHC) is facing a class action lawsuit for allegedly using an artificial intelligence (AI) system, nH Predict, to deny patient claims in Medicare Advantage plans. The lawsuit, filed in Minnesota district court, claims UHC used this technology to systematically reject skilled nursing facility (SNF) claims, contradicting Medicare’s coverage standards and doctor recommendations.
The AI model, acquired by UHC’s parent company in 2020, is accused of having a 90% error rate, leading to significant out-of-pocket expenses for patients. The lawsuit highlights two cases: Gene Lokken, who incurred about $150,000 in expenses, and Dale Tetzloff, who paid around $70,000. Both patients received less care than their doctors recommended due to the AI’s decisions.
The complaint alleges that UHC’s employees were forced to adhere to the AI model’s predictions, facing discipline or termination if they deviated, even when additional care was justified. The lawsuit raises ethical and legal concerns about replacing human judgment in healthcare with AI.
New federal rules prohibit Medicare Advantage plans from solely relying on algorithms for medical necessity determinations, emphasizing the need for individualized review by qualified healthcare professionals.
The plaintiffs, represented by Clarkson Law Firm, are seeking a jury trial and federal class action status, potentially opening the case to any U.S. resident who purchased a UHC Medicare Advantage plan in the past four years.