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After shooting, UnitedHealthcare comes under scrutiny for AI use in treatment approval

The use of AI tools in healthcare and by insurance providers has raised the question of whether high denial rates are a glitch — or a feature.

The lawsuit, filed last year in federal court in Minnesota, alleges UHC illegally denied Medicare Advantage care to elderly patients by using an AI model with a 90% error rate, overriding doctors’ judgments on the medical necessity of expenses. “Usually, any expensive drug requires a prior authorization, but denials tend to be focused on places where the insurance company thinks that a cheaper alternative is available, even if it is not as good,” Dr. Ashish Kumar Jha, dean of the School of Public Health at Brown University, explained in an earlier interview with Computerworld. Jha, who is also a professor of Health Services, Policy and Practices at Brown and served as the White House COVID-19 response coordinator in 2022 and 2023, said that while prior authorization has been a major issue for decades, only recently has AI been used to “turbocharge it” and create batch denials.

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