Incident 608: UnitedHealth Accused of Deploying Allegedly Flawed AI to Deny Medical Coverage

Description: UnitedHealthcare allegedly used a faulty AI algorithm with a 90% error rate to override doctors' recommendations and deny health coverage. This AI, developed by NaviHealth, reportedly led to premature discharge from care facilities and substantial out-of-pocket expenses for patients, according to a lawsuit filed in the District Court for Minnesota.


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Daniel Atherton
Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients · 2023

Judith Sullivan was recovering from major surgery at a Connecticut nursing home in March when she got surprising news from her Medicare Advantage plan: It would no longer pay for her care because she was well enough to go home.

At the time,…

UnitedHealth renames company responsible for massive inappropriate denials · 2023

A while back, I reported on a story in Stat News that exposed a division of UnitedHealth, NaviHealth that uses artificial intelligence, AI, to deny thousands of Medicare Advantage claims, in seconds. Now, Stat News reports that UnitedHealth…

UnitedHealth faces class action lawsuit over algorithmic care denials in Medicare Advantage plans · 2023

A class action lawsuit was filed Tuesday against UnitedHealth Group and a subsidiary alleging that they are illegally using an algorithm to deny rehabilitation care to seriously ill patients, even though the companies know the algorithm has…

Lawsuit claims UnitedHealth AI wrongfully denies elderly extended care · 2023

Nov 14 (Reuters) - UnitedHealth Group Inc (UNH.N) uses an artificial intelligence algorithm that systematically denies elderly patients' claims for extended care such as nursing facility stays, according to a proposed class action lawsuit f…

UnitedHealthcare Accused of AI Use to Wrongfully Deny Claims (1) · 2023
Ian Lopez post-incident response

Health insurer UnitedHealthcare is facing a class action alleging it used an artificial intelligence algorithm to wrongfully deny coverage to elderly people for care under their Medicare Advantage…

UnitedHealthcare hit with class action over alleged use of AI to deny Medicare Advantage claims · 2023

UnitedHealthcare is facing a potential class-action lawsuit following allegations that it used an algorithm to deny claims for post-acute care services in Medicare Advantage (MA).

The proposed class action was filed Monday by the families o…

UnitedHealth AI algorithm allegedly led to Medicare Advantage denials, lawsuit claims · 2023

A class action lawsuit filed this week alleges that healthcare giant UnitedHealth Group unlawfully used an artificial intelligence algorithm to deny rehabilitative care to sick Medicare Advantage patients.

The suit claims that UnitedHealth …

UnitedHealth Faces Lawsuit, Media Scrutiny Over AI’s Role in Medicare Advantage Denials of Nursing Home Care · 2023

UnitedHealthcare, a unit of UnitedHealth Group (NYSE: UNH), is facing a federal lawsuit over its use of an artificial intelligence tool in making Medicare Advantage claims denials for patients in extended care facilities.

That same issue wa…

UnitedHealthcare sued over AI-denied medical claims · 2023

UnitedHealthcare has been sued for allegedly denying healthcare claims based on a faulty AI model.

The lawsuit [PDF], filed Tuesday in federal court in Minneapolis on behalf of the estates of two elderly men, alleges that at least since Uni…

Lawsuit alleges UnitedHealth used AI to wrongfully deny claims · 2023

Insurance giant UnitedHealth Group is facing a lawsuit alleging it used an artificial intelligence algorithm to wrongfully deny coverage to older patients for care under its Medicare Advantage health policies, Bloomberg Law reported Nov. 14…

UnitedHealth uses AI model with 90% error rate to deny care, lawsuit alleges · 2023

UnitedHealthcare, the largest health insurance company in the US, is allegedly using a deeply flawed AI algorithm to override doctors' judgments and wrongfully deny critical health coverage to elderly patients. This has resulted in patients…

AI Ethics Essentials: Lawsuit Over AI Denial of Healthcare · 2023

UnitedHealthcare, the largest health insurance provider in the US, is currently embroiled in a class-action lawsuit alleging the wrongful denial of extended care claims for elderly patients through the use of an artificial intelligence (AI)…

UnitedHealthcare used AI to deny patients’ health insurance coverage, lawsuit says · 2023

Health insurance giant UnitedHealthcare Inc. used a flawed artificial intelligence (AI) program to deny care to senior patients using the company’s Medicare Advantage insurance, according to a new class action lawsuit.

The AI had a 90% erro…

UnitedHealth sued for allegedly using AI to deny elderly patients care · 2023

UnitedHealth Group is being sued for allegedly using an artificial intelligence algorithm to systematically deny elderly patients rehabilitative care.

The class action lawsuit, filed Tuesday in Minnesota district court, says the defendants …

UnitedHealth Group served class action lawsuit for AI-informed managed care denials · 2023

UnitedHealthcare is being sued for allegedly using unreliable artificial intelligence algorithms to wrongfully deny payment for post-acute managed care.

The three defendants named in the complaint filed Tuesday are UnitedHealth Group, its h…

Lawsuit: Health Insurer's AI Tool 'Illegally' Denies Claims · 2023

The estates of two deceased UnitedHealthcare Medicare Advantage policyholders say the insurance company is using an AI tool to illegally deny necessary coverage for post-acute care, including skilled nursing and home healthcare, to elderly …

America's Largest Health Insurer Denying Care With AI That's Wrong 90 Percent of the Time, Lawsuit Alleges · 2023

UnitedHealthcare, the largest health insurance provider in the US, is using an AI algorithm called nH Predict whose wildly inaccurate predictions are being used to deny health coverage to severely ill patients by cutting the time they can s…

Is your health insurer using AI to deny you services? Lawsuit says errors harmed elders. · 2023

For years, vital decisions about who got medical care coverage took place in back offices at health insurance companies. Now, some of those life-altering decisions are being made by artificial intelligence programs.

At least that's the cont…

UHC Accused of Using AI to Skirt Doctor Orders, Deny Claims · 2023

UnitedHealthcare (UHC) is the latest payer accused of using artificial intelligence (AI) to deny patient claims by trading "real doctors' recommendations" for a flawed algorithm to save money.

In a class action suit filed this week in Minne…

UnitedHealth uses faulty AI to deny elderly patients medically necessary coverage, lawsuit claims · 2023

The families of two now-deceased former beneficiaries of UnitedHealth have filed a lawsuit against the health care giant, alleging it knowingly used a faulty artificial intelligence algorithm to deny elderly patients coverage for extended c…

AI cannot be used to deny health care coverage, feds clarify to insurers · 2024
Beth Mole post-incident response

Health insurance companies cannot use algorithms or artificial intelligence to determine care or deny coverage to members on Medicare Advantage plans, the Centers for Medicare & Medicaid Services (CMS) clarified in a memo sent to all Medica…


A "variant" is an incident that shares the same causative factors, produces similar harms, and involves the same intelligent systems as a known AI incident. Rather than index variants as entirely separate incidents, we list variations of incidents under the first similar incident submitted to the database. Unlike other submission types to the incident database, variants are not required to have reporting in evidence external to the Incident Database. Learn more from the research paper.

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