AI Ethics

More than nine in ten of the denials that patients appealed were reversed, and only about 0.2% of policyholders appealed at all. If both numbers are right, nearly every denial that was checked on appeal was overturned, and almost none were checked. They come from a class action filed against UnitedHealth Group in November 2023 in federal court in Minnesota, which alleges that UnitedHealthcare's Medicare Advantage plans leaned on nH Predict, a model built by the subsidiary naviHealth to predict how long a patient's post-acute care should last. The first-named plaintiff is the estate of Gene Lokken. He was 91 when he fell in May 2022 and fractured his leg and ankle; according to the complaint, his plan paid for 19 days of skilled nursing care and then stopped, although his doctors recommended more rehabilitation, and his family paid about $150,000 for care until he died in July 2023.