Submitted 11 months ago by L4s@lemmy.world [bot] to technology@lemmy.world
Humana also using AI tool with 90% error rate to deny care, lawsuit claims::The AI model, nH Predict, is the focus of another lawsuit against UnitedHealth.
Did they really need an AI tool? I worked in healthcare for years before this stuff came out, and back then they didn’t need AI to blanket-deny 90% of claims without reading them. United Healthcare was/is even worse.
The difference is now they don’t need to be paying people to deny the stuff
People haven’t denied the stuff since the 1980s, it’s all been automated with rule engines. You’d never get claims paid if you had to do it all by hand.
Hopefully they use an AI lawyer to fight the oncoming massive pending class action suit
For profit healthcare is an oxymoron
So it’s working as intended for Humana?
/c/ABoringDystopia
As long as it save company money, error rate is not a concern.
It’s a goal.
Is there proof of this? My mom works for Humana doing LTC and neither she or the medical directors she forwards cases to use this tool?
It’s probably on claim submission.
My company operates as an LTC pharmacy. We pay for every claim submission whether reject or success.
I was on the phone the other day with my pharmacy (optum) and they did a “test” claim which was free for them. I know optum owns the pharmacy, insurance, and pbm, but either their abusive their vertical integration or they have an “ai” to test claims.
Proof is what the lawsuit is for.
This is the best summary I could come up with:
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.
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.
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.
Humana did not respond to Ars’ request for comment by the time this story initially published, but a spokesperson has since provided a statement, emphasizing that there is a “human in the loop” whenever AI tools are used.
In both cases, the plaintiffs claim that the insurers use the flawed model to pinpoint the exact date to blindly and illegally cut off payments for post-acute care that is covered under Medicare plans—such as stays in skilled nursing facilities and inpatient rehabilitation centers.
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originalucifer@moist.catsweat.com 11 months ago
Then it's not an error rate.
andrew@lemmy.stuart.fun 11 months ago
Which is prostitution and the Republicans definitely don’t like that right?