UnitedHealth Accused of Using Algorithm to Deny Elderly Patients Rehabilitation Care

A federal lawsuit is being tried in the US District Court for Minnesota against UnitedHealth Group, alleging that they permitted an algorithm to influence when elderly patients received enough rehabilitation care.

The case, Estate of Gene B. Lokken et al. v. UnitedHealth Group Inc. et al., was filed on November 14, 2023, and accuses UnitedHealth, UnitedHealthcare, and naviHealth of using an algorithm called NH Predict to predict patient recovery times and then limiting coverage based on those predictions.

The complaint states that case managers were pressured to adhere to the predicted discharge dates, even when treating physicians deemed continued care medically necessary. This allegedly resulted in patients being denied further treatment and left vulnerable to irreversible injury.

The business rationale behind this practice is cost containment, with UnitedHealth noting that about 90% of overturned denials were challenged but only a small percentage of patients appealed. However, the lawsuit argues that this is not justification enough for using an algorithm to make life-or-death decisions.