As evidenced in a recent suit filed against United Healthcare, providers and members have recourse when payers wrongfully deny covered claims by using artificial intelligence.
This will continue to be a hot-button issue in all of the managed care disputes our health care team litigates into the foreseeable future.
Filed Tuesday in the US District Court for the District of Minnesota, the lawsuit alleges UnitedHealthcare made health-care determinations via its “nH Predict” algorithm, overrode physician recommendations, and denied elderly patients’ claims for stays in extended care facilities. Doing so “resulted in a significant increase in the number of post-acute care coverage denials,” the lawsuit said.
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