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インシデント 608: UnitedHealth Accused of Deploying Allegedly Flawed AI to Deny Medical Coverage

レスポンスしました
概要: 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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組織

すべての組織を表示
Alleged: NaviHealth developed an AI system deployed by UnitedHealthcare, which harmed Medicare Advantage Plan Patients , Healthcare Providers (Doctors and Therapists) と elderly patients.

インシデントのステータス

インシデントID
608
レポート数
21
インシデント発生日
2023-02-28
エディタ
Daniel Atherton
Applied Taxonomies
MIT

MIT 分類法のクラス

Machine-Classified
分類法の詳細

Risk Subdomain

A further 23 subdomains create an accessible and understandable classification of hazards and harms associated with AI
 

7.3. Lack of capability or robustness

Risk Domain

The Domain Taxonomy of AI Risks classifies risks into seven AI risk domains: (1) Discrimination & toxicity, (2) Privacy & security, (3) Misinformation, (4) Malicious actors & misuse, (5) Human-computer interaction, (6) Socioeconomic & environmental harms, and (7) AI system safety, failures & limitations.
 
  1. AI system safety, failures, and limitations

Entity

Which, if any, entity is presented as the main cause of the risk
 

Human

Timing

The stage in the AI lifecycle at which the risk is presented as occurring
 

Post-deployment

Intent

Whether the risk is presented as occurring as an expected or unexpected outcome from pursuing a goal
 

Intentional

インシデントレポート

レポートタイムライン

Incident OccurrenceFeds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients+3
UnitedHealth renames company responsible for massive inappropriate denials
+14
UnitedHealth AI algorithm allegedly led to Medicare Advantage denials, lawsuit claims
AI cannot be used to deny health care coverage, feds clarify to insurers - レスポンス
Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients

Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients

kffhealthnews.org

UnitedHealth renames company responsible for massive inappropriate denials

UnitedHealth renames company responsible for massive inappropriate denials

justcareusa.org

UnitedHealthcare Accused of AI Use to Wrongfully Deny Claims (1)

UnitedHealthcare Accused of AI Use to Wrongfully Deny Claims (1)

news.bloomberglaw.com

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

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

statnews.com

Lawsuit claims UnitedHealth AI wrongfully denies elderly extended care

Lawsuit claims UnitedHealth AI wrongfully denies elderly extended care

reuters.com

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

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

healthcarefinancenews.com

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

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

fiercehealthcare.com

Lawsuit alleges UnitedHealth used AI to wrongfully deny claims

Lawsuit alleges UnitedHealth used AI to wrongfully deny claims

beckersasc.com

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

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

skillednursingnews.com

UnitedHealthcare sued over AI-denied medical claims

UnitedHealthcare sued over AI-denied medical claims

theregister.com

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

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

arstechnica.com

UnitedHealth sued for allegedly using AI to deny elderly patients care

UnitedHealth sued for allegedly using AI to deny elderly patients care

news5cleveland.com

AI Ethics Essentials: Lawsuit Over AI Denial of Healthcare

AI Ethics Essentials: Lawsuit Over AI Denial of Healthcare

forbes.com

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

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

medicaleconomics.com

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

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

mcknightshomecare.com

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

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

bankinfosecurity.com

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

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

futurism.com

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

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

usatoday.com

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

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

medscape.com

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

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

cbsnews.com

AI cannot be used to deny health care coverage, feds clarify to insurers

AI cannot be used to deny health care coverage, feds clarify to insurers

arstechnica.com

Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients
kffhealthnews.org · 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
justcareusa.org · 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…

UnitedHealthcare Accused of AI Use to Wrongfully Deny Claims (1)
news.bloomberglaw.com · 2023
Ian Lopezによるインシデント後のレスポンス
  • COURT: D. Minn.
  • TRACK DOCKET: 23-cv-03514

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…

UnitedHealth faces class action lawsuit over algorithmic care denials in Medicare Advantage plans
statnews.com · 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
reuters.com · 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…

UnitedHealth AI algorithm allegedly led to Medicare Advantage denials, lawsuit claims
healthcarefinancenews.com · 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 …

UnitedHealthcare hit with class action over alleged use of AI to deny Medicare Advantage claims
fiercehealthcare.com · 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…

Lawsuit alleges UnitedHealth used AI to wrongfully deny claims
beckersasc.com · 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 Faces Lawsuit, Media Scrutiny Over AI’s Role in Medicare Advantage Denials of Nursing Home Care
skillednursingnews.com · 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
theregister.com · 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…

UnitedHealth uses AI model with 90% error rate to deny care, lawsuit alleges
arstechnica.com · 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…

UnitedHealth sued for allegedly using AI to deny elderly patients care
news5cleveland.com · 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 …

AI Ethics Essentials: Lawsuit Over AI Denial of Healthcare
forbes.com · 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
medicaleconomics.com · 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 Group served class action lawsuit for AI-informed managed care denials
mcknightshomecare.com · 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
bankinfosecurity.com · 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
futurism.com · 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.
usatoday.com · 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
medscape.com · 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
cbsnews.com · 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
arstechnica.com · 2024
Beth Moleによるインシデント後のレスポンス

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…

バリアント

「バリアント」は既存のAIインシデントと同じ原因要素を共有し、同様な被害を引き起こし、同じ知的システムを含んだインシデントです。バリアントは完全に独立したインシデントとしてインデックスするのではなく、データベースに最初に投稿された同様なインシデントの元にインシデントのバリエーションとして一覧します。インシデントデータベースの他の投稿タイプとは違い、バリアントではインシデントデータベース以外の根拠のレポートは要求されません。詳細についてはこの研究論文を参照してください

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