Insurers Turn to AI to Deny Medical Care Claims

The use of AI in healthcare has led to a new concern for patients and doctors alike. UnitedHealth Group, the largest health insurer in the US, has been accused of using an AI algorithm called nH Predict to deny payments to people, despite their doctors saying the care was necessary.

This is not an isolated incident, as Humana and Cigna are also facing litigation over similar allegations. Meanwhile, Medicare has launched its own AI tool that will help determine whether to approve prior authorizations.

According to a lawsuit filed by Gene Lokken's family, UnitedHealth denied any more services at the nursing facility where Lokken had been for two months after July 20. The insurer claimed that Lokken could be safely discharged and more time at the nursing care facility 'was not medically necessary.'

The complaint alleges that the AI model would typically start denying claims after two weeks of nursing home care.