We're Deploying AI Like It's Been Tested. It Hasn't.
An elderly Medicare patient needs post-acute rehabilitation care. Their doctor says so. The hospital says so. UnitedHealthcare’s AI model disagrees. A class action lawsuit filed in November 2023 alleged that UnitedHealth’s algorithm, called nH Predict, was denying rehabilitation coverage to seriously ill patients at scale, including cases involving feeding tubes and severe pressure wounds. The lawsuit alleged that nine out of ten of those denials were overturned on appeal. A U.S. Senate Permanent Subcommittee on Investigations report, published in October 2024, found that UnitedHealthcare’s prior authorization denial rate for post-acute care jumped from 10.9 percent in 2020 to 22.7 percent in 2022, as the company was implementing automated review processes. The lawsuit further alleged UnitedHealth knew about the error rate and kept using the model anyway, because only 0.2 percent of denied patients actually appeal. ...