Humana sued for using AI to deny health insurance
A class-action lawsuit accused US healthcare insurer Humana of illegally using the nH Predict AI mode l to override physicians' recommendations and prematurely terminate rehabilitation coverage for elderly patients. What happened I n November 2021, one of the plaintiffs, 86-year-old JoAnne Barrows, was discharged to a rehabilitation facility after being hospitalised following a fall. She was under a non-weight-bearing order for six weeks due to a leg injury, according to the lawsuit. Humana informed Barrows that it would cancel her coverage after just two weeks in the rehabilitation facility, according to the lawsuit, though she was to be non-weight-bearing for an additional month. She appealed the decision but was denied, forcing her family to pay out-of-pocket for the rehab she needed, according to the suit. Humana responded by saying it uses 'various tools, including augmented intelligence to expedite and approve utilization management requests,' and that the company 'maintains a 'human in the loop' decision-making whenever AI is utilized.' How it happened The lawsuit alleges Humana used the AI system to save money by denying claims they are obligated to pay, cut off payment for nursing home stays much earlier than the typical 100-day coverage period, and systematically deny care to elderly patients, shifting financial responsibility to taxpayers or patients themselves. What it means The implications of the case are seen to include the p otential violation of laws requiring medical professionals to make coverage decisions and increased scrutiny of AI applications in insurance claim processing. System 🤖 nH Predict Operator: Humana Inc Developer: Cardinal Health; Optum; SeniorMetrix; UnitedHealth Group Country: USA Sector: Health Purpose: Predict post-acute care needs Technology: Prediction algorithm Issue: Accuracy/reliability; Accountability Legal, regulatory 👩🏼⚖️ Barrows et al v Humana Inc
- Date it happened
- 2023-12-01
- Organisation involved
- Humana Inc
- Product, system or model
- nH Predict
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