nH Predict

Transparency and accountability 🙈

nH Predict has been accused of having significant transparency and accountability limitations, including: 

• Public information. UnitedHealth Group provides very little information about the algorithm to patients and potential patients

• Black box decision-making. The algorithm's decision-making process is highly opaque, making it difficult for healthcare providers, patients and others to understand how care predictions are made

• Trade secrecy. Insurers have been discovered denying patients access to their nH Predict reports on the basis that the information is commercially sensitive and proprietary

• Independent auditing. UnitedHealth Group does not allow independent third-party audits or assessments of the algorithm's performance.

Risks and harms 🛑

A number of serious allegations have been made against nH Predict, including: 

• Having a very high error rate, suggesting major inaccuracies in its predictions

• Automatically prematurely cutting off payments for patient treatment, particularly for elderly and disabled patients

• Overriding medical expertise. Clinicians have reported that UnitedHealth bosses allow nH Predict to override their medical expertise

• Potentially perpetuating or exacerbating health inequalities.

Legal, regulatory 👩🏼‍⚖️

• Barrows et al v Humana Inc

• Estate of Gene B. Lokken and the Estate of Dale Henry Tetzloff v UNITEDHEALTH GROUP, INC., UNITEDHEALTHCARE, INC., NAVIHEALTH, INC., and DOES 1-50, inclusive

Research, advocacy 🧮

• Be a Hero Fund. Tell Biden: Stop Death by AI

• Talia D. (2024). Algorithms That Can Deny Care, and a Call for AI Explainability

• Mello M.M., Rose S. (2024). Denial - Artificial Intelligence Tools and Health Insurance Coverage Decisions

• Center for Medicare Advocacy (2022). The Role of AI-Powered Decision-Making Technology in Medicare Coverage Determinations

• Lam T. et al (2022). Randomized Controlled Trials of Artificial Intelligence in Clinical Practice: Systematic Review

Investigations, assessments, audits 👁️

• U.S. Senate Permanent Subcommittee on Investigations. Refusal of Recovery - How Medicare Advantage insurers have denied patients access to acute care

• STAT (2023). How UnitedHealth’s acquisition of a popular Medicare Advantage algorithm sparked internal dissent over denied care

• STAT (2023). Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

• STAT (2023). Buyer’s remorse: How a Medicare Advantage business is strangling one of its first funders