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UnitedHealthcare is under scrutiny for allegedly using AI algorithms to deny Medicare Advantage claims. A Senate subcommittee report highlighted a significant increase in denial rates for post-acute care, rising from 10.9% in 2020 to 22.7% in 2022. The report suggests that the company's automation initiatives may have contributed to this troubling trend.
The report indicates that denial rates for skilled nursing centers have surged dramatically, with claims denied in 2022 being nine times higher than in 2019. UnitedHealthcare's use of AI in the prior authorization process has raised concerns about the accuracy and fairness of these decisions. A recent class-action lawsuit further alleges that the company relies on a flawed AI model with a 90% error rate to deny necessary care for elderly patients.
• UnitedHealthcare's denial rates for post-acute care have sharply increased.
• A class-action lawsuit claims AI is used to wrongfully deny Medicare claims.
In this context, AI is used by UnitedHealthcare to automate the prior authorization process for medical claims.
UnitedHealthcare explored using machine learning to predict which claims denials would likely be appealed.
The report discusses how UnitedHealthcare's algorithm is allegedly responsible for systematically denying claims based on flawed criteria.
S., facing allegations of using AI to deny Medicare claims unfairly.
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