Following the murder of UnitedHealthcare CEO Brian Thompson, resurfacing are now reports of a lawsuit filed a year ago, in which the health insurance company has been accused of using Artificial Intelligence (A.I.) to deny one-third of claims filed by sick patients, more than most insurers report.
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As we previously shared, on December 4, UnitedHealthcare (UHC) CEO Brian Thompson was murdered in Midtown, New York, and the bullet casings from the ammunition that killed Thompson reportedly had the words: “Deny,” Defend,” and “Depose,” written on them. Reportedly, these words have been used to describe the strategy and tactics that health insurance companies, like UnitedHealthcare, use to deny claims by its sick patients.
Just over a year before UnitedHealthcare CEO Brian Thompson was murdered, a lawsuit was filed against the insurance company, accusing it of relying on Artificial Intelligence (A.I.) to deny thousands of claims filed by sick patients. Last November, the estates of two former UHC patients filed a lawsuit in Minnesota alleging the insurer used an A.I. algorithm to deny and override claims to elderly patients already approved by their doctors.
According to the families of two deceased men who filed the lawsuit against UnitedHealthcare, the A.I. algorithm used is known as nH Predict, and it allegedly had a 90 percent error rate, which UHC reportedly knew about. Speculation circulates regarding the correlation between the lawsuit, the CEO’s death, and the words allegedly written on the shell casings. However, nothing has been confirmed.
Additionally, according to FOX Business, an October report, titled ‘How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care,’ Democrats on the U.S. Senate Permanent Subcommittee on Investigations (PSI) claimed UnitedHealthcare’s prior authorization denial rate for post-acute care leaped from 10.9% in 2020 to 22.7% in 2022. According to Forbes, the insurer refused an estimated one-third of claims submitted by sick patients, more than most insurers.
The October report claimed that UnitedHealthcare’s denial rates for skilled nursing centers, specifically, “experienced particularly dramatic growth.” The report revealed that the number of denied claims in 2022 jumped nine times higher than compared to the numbers in 2019. During this time, the company is said to have “implemented multiple initiatives to automate the process.”
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The report explained, “[UnitedHealthcare] processed far more home health service authorizations for Medicare Advantage members during this period, underscoring concerns about insurers rejecting placements in post-acute care facilities in favor of less costly alternatives.”
Responding to the claims in October, FOX Business said that UnitedHealthcare released a statement stating it “mischaracterizes the Medicare Advantage program and our clinical practices, while ignoring CMS criteria demanding greater scrutiny around post-acute care.”
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