UnitedHealth algorithm accused of systematically limiting mental health coverage

UnitedHealth Group is systematically limiting mental health coverage using an algorithm that has been deemed illegal in three US states , according to media reports, raising questions about the company's ethics and priorities. What happened US health insurer UnitedHealth Group's use of its AI-powered ALERT system to identify patients receiving what it considers excessive mental health therapy has led to denials of coverage for many individuals, despite the model being banned in three US states, according to non-profit newsroom ProPublica . ALERT (Algorithms for Effective Reporting and Treatment) is a suite of algorithms that was originally designed to identify patients at risk of suicide or substance use but was repurposed to analyse clinical and claims data for unusual treatment patterns and flag what the company considers "overuse" of therapy. ProPublica's investigation revealed that the company's algorithms flag patients based on treatment frequency, such as those attending more than 30 sessions in eight months or having sessions twice a week for extended periods. The result is a significant risk of losing access to necessary mental health services for vulnerable populations. Despite having been ruled illegal in California, Massachusetts and New York, the company's Optum subsidiary has persisted in employing what are seen as arbitrary thresholds and cost-driven strategies to manage mental health care access. Why it happened The use of algorithms to limit care stems from a broader trend in the insurance industry in which companies seek to maximise profit by controlling costs. Although the US' Mental Health Parity and Addiction Equity Act mandates equal access to mental health care compared to physical care, insurers are allowed considerable discretion in determining what constitutes "medically necessary" treatment. The regulatory environment enables practices that prioritise financial considerations over patient needs, often resulting in stricter limitations on mental health services. What it means UnitedHealth Group's practices are seen to highlight major gaps in regulatory oversight and accountability within the US mental health care system. As patients face increasing barriers to accessing essential services, advocates argue that these actions not only violate existing laws but also jeopardise the mental well-being of countless individuals. The situation underscores the urgent need for stronger regulations and enforcement mechanisms to ensure mental health coverage is treated equitably alongside physical health care. System 🤖 ALERT Developer: UnitedHealth Group; Optum Country: USA Sector: Health Purpose: Analyse clinical and claims data Technology: Machine learning; Pattern recognition; Risk assessment algorithm Issue: Fairness Investigations, assessments, audits 👁️ ProPublica . How UnitedHealth’s Playbook for Limiting Mental Health Coverage Puts Countless Americans’ Treatment at Risk

Date it happened

2024-01-01

Product, system or model

ALERT

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