The manhunt for the gunman who killed UnitedHealthcare CEO Brian Thompson is underway, and police believe the CEO was the target.
Democrats on a Senate subcommittee are accusing UnitedHealthcare Group of denying claims to a growing number of patients in an effort to use artificial intelligence to automate processes.
Democrats on the U.S. Senate Permanent Subcommittee on Investigations (PSI) in an October report, “How Medicare Advantage Insurers Denied Patients’ Access to Post-Acute Care,” released a report claiming that the post-care prior authorization denial rate had jumped from 10.9. % in 2020 to 22.7% in 2022.
In particular, skilled nursing centers’ rejection rates “experienced a particularly dramatic increase.” According to the report, the number of claim denials in 2022 was nine times higher than in 2019.
During the same period, the company “implemented multiple initiatives to automate processes,” according to the report.
UnitedHealthcare CEO shot dead in ‘targeted’ attack outside Manhattan hotel. big suspect
UnitedHealthcare CEO Andrew Whitty sent this message to employees at the major insurance company hours after CEO Brian Thompson was shot and killed outside a Manhattan hotel on December 4th.
The report also notes that United Airlines “processed far more home health service authorizations for Medicare Advantage members during this period, with insurers prioritizing cheaper alternative facilities for post-acute care.” “This highlights concerns about refusing admission to the facility.”
FOX Business has reached out to United for comment. The company said in a statement in October that the report “mischaracterizes the Medicare Advantage program and our clinical practices, and ignores CMS standards that require greater scrutiny of post-acute care.” he vehemently criticized.
What is artificial intelligence (AI)?
The report comes as the largest health insurance company has come under fire for allegedly unfairly denying claims in recent months. The killing of UnitedHealthcare CEO Brian Thompson in New York on Wednesday prompted more critics to voice their dissatisfaction with the company.
A United Healthcare sign outside a store in Queens, New York, on January 14, 2013. (Michael Nagle/Bloomberg via Getty Images/Getty Images)
In April 2021, the United Health Care Board approved the use of “machine-assisted prior authorization” to expedite the review process for medical requests, according to a PSI report. The committee was told that a doctor or nurse still needed to review the evidence, but tests showed the technology had potential. According to the report, review time was reduced by 6 to 10 minutes.
UnitedHealthcare tested a new “HCE Auto-Authentication Model” in early 2021, and records of internal meetings revealed it resulted in “improved processing times” for cases. However, the report said there was also an increase in the number of cases rejected because the system caught errors that were missed during the initial review. The commission voted to tentatively approve the model at a meeting a month later, the report said.
In December 2022, United Healthcare’s group will use AI and “machine learning” to determine which post-acute care case denials are likely to be appealed and which appeals are likely to be overturned. We investigated a method for predicting whether a person’s gender is high.
Who is UnitedHealthcare CEO Brian Thompson?
This 2017 file photo of Brian Thompson was published via Businesswire when he was named CEO of UnitedHealthcare in 2017. (Business Wire/Fox News)
Nearly a year later, in November 2023, the nation’s largest insurance company accused it and its subsidiary NaviHealth of relying on computer algorithms to “systematically deny claims” to Medicare beneficiaries in nursing homes. It was hit with a class action lawsuit. He struggled to recover from a debilitating illness.
The complaint alleges that the company “substituted artificial intelligence (AI) for Medicare Advantage plans by replacing actual medical professionals and overriding attending physicians’ decisions about medically necessary care based on the AI model.” “The law illegally denies elderly people the care they are required to receive based on the law,” the lawsuit said. ”
The lawsuit also claimed that the company knew the model “had a 90% error rate.”
prescription drugs in usd (license/image)
The complaint goes on to allege that despite high error rates, the company and its subsidiaries “continue to systematically deny claims using flawed AI models” because policyholders Only about 0.2% of Americans actually appeal their denied insurance claims, and the majority said it was because they knew they would appeal one way or another. Pay out-of-pocket costs or waive the remainder of the prescribed post-acute treatment.
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“Defendants rely on patients’ impaired conditions, lack of knowledge, and lack of resources to litigate erroneous decisions made by the AI,” the lawsuit continued.
The lawsuit was filed shortly after a Stat News investigation found that UnitedHealth pressured employees to use algorithms aimed at cutting off rehabilitation treatment for Medicare patients.
The investigation found that the algorithm was predicting a patient’s length of stay and denying payments to individuals with Medicare Advantage plans.
