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UnitedHealth uses faulty AI to deny elderly patients medically necessary coverage, lawsuit claims
Families of former beneficiaries claim UnitedHealth's AI system "aggressively" rejected claims for medically necessary expenses.
The use of the allegedly defective AI model, developed by NaviHealth and called "nH Predict," enabled the insurance company to "prematurely and in bad faith discontinue payment" to its elderly beneficiaries, causing them medical or financial hardships, the lawsuit states. Our Mistake is Your Responsibility | Sunday on 60 Minutes00:30 Aaron Albright, a spokesperson for NaviHealth told CBS MoneyWatch that the AI-powered tool is not used to make coverage determinations but as "a guide to help [UnitedHealth] inform providers ... about what sort of assistance and care the patient may need." In their complaint, however, the families accuse UnitedHealth of using faulty AI to deny claims as part of a financial scheme to collect premiums without having to pay for coverage for elderly beneficiaries it believes lack the knowledge and resources "to appeal the erroneous AI-powered decisions."
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