Major Federal Class-Action Filed Against United Healthcare Seeking to Protect Elderly Patients From Artificial Intelligence Wrongfully Denying Health Care Claims
Today, Clarkson Law Firm, one of the leading public interest law firms in the country, filed a federal class action lawsuit in US District Court for the District of Minnesota against United Healthcare, the largest and most profitable health insurance provider in the nation.
The suit alleges that after purchasing Navihealth, a third-party company that created an artificial intelligence program to evaluate insurance claims, United Healthcare has consistently and wrongfully used this technology to deny older patients’ insurance claims for doctor-recommended stays in extended care facilities, heaping unwarranted medical debt on patients during difficult recoveries.
“UnitedHealthcare is responsible for the health care needs of some of our most vulnerable populations,” said Ryan Clarkson, managing partner of Clarkson Law. “But by invoking this technology, they are effectively using AI to throw the elderly – our parents or grandparents – out onto the street.”
nH Predict, UnitedHealth’s newly purchased AI algorithm, compares a patient’s demographic and medical information against a database of other similar patients, and – without input or oversight from a doctor – uses only that information to determine how many days United Healthcare will approve a necessary stay at a care facility, often undercutting the amount of time recommended by a doctor.
Importantly, when these decisions are appealed – which introduces licensed medical oversight for the first time in the entire approval process – there is a 90% reversal rate. Currently, only around 0.2% of patients submit their claims for appeals, leaving the overwhelming majority of patients over 60 to deal with the financial burdens imposed by having to pay out of pocket for the rest of their stay at a care facility.
“While AI technology holds incredible promise to advance the healthcare industry, United Healthcare’s algorithm is a prime example of the real harm it is causing when left unchecked,” said Glenn Danas, partner at Clarkson Law Firm. “This is a fundamental question about whether AI is used to serve the public’s interests – or to line insurers’ pockets at their patients’ expense.”
What this lawsuit will demonstrate is that as AI technology becomes more powerful by the day, United Healthcare’s use of AI cuts corners on insurance claims and takes advantage of injured, ill, and elderly patients without any kind of accountability. United Healthcare’s decision to automate this integral step in the claim process is actively leaving elderly patients unable to access and afford the very same care their doctors have ordered.
“Every patient is entitled to a nuanced evaluation of their health care needs,” said Zarrina Ozari, senior associate at Clarkson Law Firm. “By replacing licensed practitioners with unchecked AI, United Healthcare is telling its patients that they are completely interchangeable with one another, and undervaluing the expertise of the physicians devoted to key elements of care.”
The lawsuit, filed on behalf of United Healthcare health insurance policyholders, seeks to remedy UnitedHealth’s unlawful conduct by cessation of use of AI to supplant doctor’s orders; emotional distress damages, compensatory damages and punitive damages.
