Humana, one the nation's largest health insurance providers, is allegedly using an artificial intelligence model with a 90 percent error rate to override doctors' medical judgment and wrongfully deny care to elderly people on the company's Medicare Advantage plans.
According to a lawsuit filed Tuesday, Humana's use of the AI model constitutes a "fraudulent scheme" that leaves elderly beneficiaries with either overwhelming medical debt or without needed care that is covered by their plans. Meanwhile, the insurance behemoth reaps a "financial windfall."
The lawsuit, filed in the US District Court in western Kentucky, is led by two people who had a Humana Medicare Advantage Plan policy and said they were wrongfully denied needed and covered care, harming their health and finances. The suit seeks class-action status for an unknown number of other beneficiaries nationwide who may be in similar situations. Humana provides Medicare Advantage plans for 5.1 million people in the US.
It is the second lawsuit aimed at an insurer's use of the AI tool nH Predict, which was developed by NaviHealth to forecast how long patients will need care after a medical injury, illness, or event. In November, the estates of two deceased individuals brought a suit against UnitedHealth—the largest health insurance company in the US—for also allegedly using nH Predict to wrongfully deny care.
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Standard Medicare is 100% better than Humana Managed Care if you have many co-morbidities and are sickly. In some cases it may benefit a few patients to have Humana, depending on area and physician availability. In this area, private practice providers won’t accept it because it doesn’t pay.
So our death panels are ai? Great