Before the CEO of UnitedHealthcare was killed, a lawsuit had been filed against the insurance giant, accusing the company of using a flawed Artificial Intelligence tool to deny claims that doctors had already approved.
In November 2023, two families filed a lawsuit, claiming that UnitedHealthcare employed an AI algorithm to reject coverage for patients, even though doctors had deemed the care necessary.
Both families lost a loved one who was covered by the insurance company, as reported by Newsweek.
“The fraudulent scheme provides the Defendants with a clear financial benefit in the form of policy premiums without having to pay for promised care, while the elderly are prematurely forced out of care facilities nationwide or have to deplete family savings to continue receiving essential medical care, all because an AI model ‘disagrees’ with their real-life doctors’ decisions,” the lawsuit stated, according to Newsweek.
The lawsuit further alleged that UnitedHealthcare was aware that the AI tool, developed by NaviHealth (also named in the lawsuit), had a “90% error rate,” as CBS News reported when the lawsuit was first filed.
UnitedHealthcare defended its use of the tool, stating in November 2023 to Fierce Healthcare that the “tool is not used to make coverage decisions” but instead serves as a “guide to help inform providers, families, and other caregivers” about potential future needs for the patient.
The lawsuit is still ongoing.
CEO Brian Thompson was shot and killed in New York City on Wednesday in what police described as a targeted attack. No arrests have been made in connection with the shooting.
The words “deny,” “defend,” and “depose” were found engraved on the bullets used in the attack, which many have linked to the book Deny, Defend, Depose, a critique of insurance practices. However, a motive for the attack has not yet been determined.
According to reports cited by Forbes, UnitedHealthcare denies claims at nearly twice the rate of other insurance companies. Some hospital systems have even stopped accepting the company’s insurance coverage.
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