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UnitedHealthcare under fire for using AI to deny Medicare claims


UnitedHealthcare’s denial rates for skilled nursing centers 'experienced particularly dramatic growth.'

In a statement issued in October, the company lambasted the report, saying it "mischaracterizes the Medicare Advantage program and our clinical practices, while ignoring CMS criteria demanding greater scrutiny around post-acute care." Nearly a year later, in November 2023, the nation's largest insurance company was hit with a class-action lawsuit accusing it and its subsidiary, NaviHealth, of relying on a computer algorithm to "systematically deny claims" of Medicare beneficiaries in nursing homes that had struggled to recover from debilitating illnesses. The suit was filed shortly after an investigation by Stat News found that UnitedHealth pressured employees to use an algorithm that was aimed at cutting off rehab care for Medicare patients.

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