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this post was submitted on 19 Nov 2023
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UnitedHealthcare, is being sued over claims it is using a flawed AI model. The system is said to have wrongfully denied health coverage to critical elderly patients and disagreed with doctors' determinations.
The lawsuit followed an investigation by Stat News about the use of an AI algorithm called nH Predict developed by Navihealth. The algorithm is used to anticipate how long patients will stay in rehab following acute injuries, illness, or events. Post-acute care includes the likes of nursing homes and rehab centers. The algorithm reportedly does this by examining a database of medical cases from 6 million patients and estimating a patients' medical requirements and length of stay.
The lawsuit alleges that the AI system has a 90% error rate and overruled the post-acute care opinions of physicians.
The fact that insurance companies don't have to defer to physicians for medical decisions is mind boggling.
Their excuse is that they aren’t “overruling the doctor”, they just aren’t going to pay for it. Never mind that in the US it’s functionally the same thing.
They will just say “you do what you think is best for the patient doc. We just disagree and aren’t going to cover it.” It forces doctors, hospitals, rehabs, and nursing homes into situations where they either have to provide care for free, or not at all. I’ll never understand how we allowed things to get this bad.
Seems criminal tbh. In a decent society.