Algorithm Lawsuits: Unraveling the Impact of AI on Health Insurance Claims
In recent legal battles, health insurance payers face scrutiny for the misuse of artificial intelligence (AI) tools, sparking lawsuits and raising concerns about fair claims processing.
1. Humana Faces Legal Action Over nHPredict AI Tool
Humana is now embroiled in a lawsuit filed in the U.S. District Court for the Western District of Kentucky, accusing the insurer of using the nHPredict AI tool to wrongfully deny Medicare Advantage claims. This adds to the growing number of cases against major insurers for their alleged misuse of automated data tools.
Read more about the latest AI lawsuit
2. UnitedHealthcare’s Alleged Misuse of nH Predict AI Model
UnitedHealthcare faces allegations of using the “nH Predict” AI model with a reported 90% error rate to deny health coverage, resulting in premature discharges and financial burden on patients. The lawsuit filed in Minnesota claims breach of contract, unjust enrichment, and insurance law violations, seeking damages and an end to AI-based claims denials.
Learn more about the UnitedHealthcare lawsuit
3. AI Impact on Medicare Patients’ Rehab Care
UnitedHealth’s AI algorithm allegedly influences decisions to cut off Medicare patients’ rehab care, prioritizing cost-cutting over patient well-being. The algorithm guides decisions, and employees are penalized for deviating from its determinations. This narrative challenges the healthcare giant’s commitment to patient care and raises questions about the ethical use of AI in healthcare.
Watch the video for a compelling discussion on the lawsuit
4. Cigna Faces Lawsuits Over Automated Mass Claims Denials
Cigna is under fire for automated mass claims denials, facing lawsuits from a Minnesota member and a shareholder in Delaware. The complaints allege automatic coverage denials due to the PxDx tool, leading to medical bills sent to collections. As these lawsuits unfold, they shed light on the potential mismanagement and breaches of fiduciary duty, prompting further investigations.
Explore the latest allegations against Cigna
Stay informed about the evolving landscape of AI in health insurance and the legal challenges reshaping the industry. It’s important to ensure insurers are playing fair and held accountable for potential misdeeds – and litigation is a powerful way to ensure payers are held accountable.
