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. 

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.