UnitedHealth Sued for Using Flawed AI Tool to Deny Care to Elderly Patients

A proposed class-action lawsuit has been filed against UnitedHealth Group, its subsidiary NaviHealth, and UnitedHealthcare over allegations that they used an AI tool with a high error rate to deny care to elderly Medicare Advantage patients.

The nH Predict tool is said to have incorrectly predicted discharge dates for these patients, leading to significant financial burdens on their families. The plaintiffs claim that the companies deployed this algorithm despite being aware of its 90% error rate and used it to override the judgments of treating physicians.

Families of two deceased Medicare Advantage patients, Gene Lokken and Dale Tetzloff, have put specific dollar figures to what they believe was lost due to the algorithm's inaccuracy. According to the complaint, their families paid around $220,000 combined out of pocket for care that UnitedHealth allegedly denied.

NaviHealth case managers were reportedly measured against the algorithm's predictions rather than the patients' actual needs, creating pressure on staff to adhere to the tool's projected discharge dates. The company claims that nH Predict is used as a guide and not to make coverage determinations, but plaintiffs argue this is an attempt to deflect responsibility.