Humana sued for using AI to unfairly deny health insurance to elderly patients
Occurred: December 2023
Report incident π₯ | Improve page π | Access database π’
A class-action lawsuit accused US healthcare insurer Humana of illegally using the nH Predict AI model to override physicians' recommendations and prematurely terminate rehabilitation coverage for elderly patients.
What happened
In November 2021, one of the plaintiffs, 86-year-old JoAnne Barrows, was discharged to a rehabilitation facility after being hospitalised following a fall. She was under a non-weight-bearing order for six weeks due to a leg injury, according to the lawsuit.Β
Humana informed Barrows that it would cancel her coverage after just two weeks in the rehabilitation facility, according to the lawsuit, though she was to be non-weight-bearing for an additional month. She appealed the decision but was denied, forcing her family to pay out-of-pocket for the rehab she needed, according to the suit.
Humana responded by saying it uses 'various tools, including augmented intelligence to expedite and approve utilization management requests,' and that the company 'maintains a 'human in the loop' decision-making whenever AI is utilized.'
How it happened
The lawsuit alleges Humana used the AI system to save money by denying claims they are obligated to pay, cut off payment for nursing home stays much earlier than the typical 100-day coverage period, and systematically deny care to elderly patients, shifting financial responsibility to taxpayers or patients themselves.
What it means
The implications of the case are seen to include the potential violation of laws requiring medical professionals to make coverage decisions and increased scrutiny of AI applications in insurance claim processing.
System π€
Operator: Humana Inc
Developer: Cardinal Health; Optum; SeniorMetrix; UnitedHealth Group
Country: USA
Sector: Health
Purpose: Predict post-acute care needs
Technology: Prediction algorithm
Issue: Accuracy/reliability; Accountability
Legal, regulatory π©πΌββοΈ
News, commentary, analysis ποΈ
https://www.axios.com/2023/12/13/humana-ai-lawsuit-deny-care-seniors-rehabilitation
https://www.statnews.com/2023/12/12/humana-algorithm-medicare-advantage-patients-lawsuit/
https://www.healthcaredive.com/news/humana-lawsuit-algorithm-medicare-advantage-deny-claims/702403/
https://www.modernhealthcare.com/legal/humana-ai-medicare-advantage-lawsuit-unitedhealth-cigna
Page info
Type: Incident
Published: December 2023
Last updated: December 2024