Major Federal Class-Action Lawsuit Filed Against Humana Healthcare, Citing Use of Artificial Intelligence to Deny Insurance Claims
Today, Clarkson Law Firm, one of the leading public interest law firms in the country, filed a class-action lawsuit in the Western District of Kentucky against Humana Healthcare, the fourth-largest healthcare provider in the country, for their alleged illegal use of an artificial intelligence program to deny and shortchange valid patient claims.
The Humana case comes on the heels of Clarkson’s recent landmark lawsuit against UnitedHealth Group for their alleged use of an artificial intelligence model called nH Predict to routinely deny elderly patient’s claims in extended care facilities. Through their ongoing investigation and conversations with patients, doctors, and whistleblowers, Clarkson has uncovered a pervasive pattern of major health insurance companies utilizing AI to reject claims without any medical oversight.
“When we first looked into artificial intelligence from a consumer protection perspective, we believed it might be used by companies to better serve their customers’ needs,” said Ryan Clarkson, managing partner of Clarkson Law. “What we discovered was far more concerning and widespread – companies are prioritizing profits over their customers’ needs. Humana is not the first nor the last major insurance company utilizing AI to cut corners, and take advantage of their elderly policyholders in the process.”
Clarkson’s lawsuit alleges that Humana is illegally deploying artificial intelligence in place of real medical professionals to wrongfully deny elderly patients care owed to them under Medicare Advantage Plans, and overriding their treating physicians’ determinations as to medically necessary care based on nH Predict AI model predictions that Humana knows is highly inaccurate and is not based on patients’ medical needs.
“Our cases suggest that Humana, United, Cigna, and potentially many other healthcare providers are disregarding their patients’ doctor-recommended treatments, and padding their pockets with the resulting profits,” said Glenn Danas, partner at Clarkson Law Firm. “The bottom line is that patients can’t afford for faulty technology to become an industry standard.”
Though AI holds the potential to streamline medical administration and improve care, early adoption of these technologies without appropriate enforcement and oversight is creating a system that strips necessary care away from patients. Elderly patients recovering from long-term injuries are especially vulnerable to AI censorship; when healthcare providers’ algorithms dismiss their claims, many have no choice but to either forego the healthcare they need or to pay out of pocket for their time at extended care facilities, adding crippling medical debt to their existing concerns.
“If some of the nation’s top healthcare providers are using this AI technology, the impact on patients will be almost unfathomable,” said Zarrina Ozari, senior associate at Clarkson Law Firm. “Through this lawsuit, we are hoping to hold Humana and other bad actors accountable, and reverse this trend across the industry to re-establish high-quality standards of care.”
The lawsuit, filed on behalf of Humana health insurance policyholders, seeks to remedy Humana’s unlawful conduct by cessation of use of AI to supplant doctor’s orders; emotional distress damages, compensatory damages and punitive damages.
