NH Predict

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nH Predict is a computer program developed by naviHealth that implements an algorithm that has allegedly been used by health insurance companies including United Healthcare and Humana [1] [2] to automatically deny coverage to patients. [3] [4] [5] It is reported to work by cross-correlating patient health records with those of other patients. [6]

It is estimated that such software automates away 50–75% of human labor that would be involved in such tasks. [7]

A class action lawsuit (Estate of Gene B. Lokken et al. v. UnitedHealth Group, Inc. et al.) was filed in November 2023 against UnitedHealth Group regarding use of this software. [8] [9] [10] UnitedHeath Group have stated that the lawsuit is unjustified. [9]

References

  1. ↑ Mole, Beth (8 February 2024). "AI cannot be used to deny health care coverage, feds clarify to insurers". Ars Technica.
  2. ↑ "AIAAIC - NaviHealth nH Predict post-acute care predictions". www.aiaaic.org. Archived from the original on 2024-10-04. Retrieved 2024-12-06.
  3. ↑ Michelle M. Mello, Sherri Rose (7 March 2024). "Denial—Artificial Intelligence Tools and Health Insurance Coverage Decisions". JAMA Health Forum. 5 (3). JAMA Forum: e240622. doi:10.1001/jamahealthforum.2024.0622. PMID   38451493. Archived from the original on 7 December 2024. Retrieved 6 December 2024.
  4. ↑ Al-Sibai, Noor (December 5, 2024). "Murdered Insurance CEO Had Deployed an AI to Automatically Deny Benefits for Sick People". Yahoo News. Archived from the original on December 6, 2024. Retrieved December 6, 2024.
  5. ↑ Stanton, Andrew (December 5, 2024). "A year before CEO shooting, lawsuit alleged UHC used AI to deny coverage". Newsweek. Archived from the original on December 6, 2024. Retrieved December 6, 2024.
  6. ↑ Jaffe, Susan (2023-10-05). "Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients". KFF Health News. Archived from the original on 2024-12-06. Retrieved 2024-12-06.
  7. ↑ "UnitedHealth uses faulty AI to deny elderly patients medically necessary coverage, lawsuit claims - CBS News". www.cbsnews.com. November 20, 2023.
  8. ↑ Talia, Domenico (July 2024). "Algorithms That Can Deny Care, and a Call for AI Explainability". Computer. 57 (7): 109–112. Bibcode:2024Compr..57g.109T. doi:10.1109/MC.2024.3387012. ISSN   0018-9162.
  9. 1 2 "Lawsuit Filed Against UnitedHealth Group, Subsidiary for Use of AI to Deny Care". wha.org. Archived from the original on 2024-08-08. Retrieved 2024-12-06.
  10. ↑ "Estate of Gene B. Lokken et al. v. UnitedHealth Group, Inc. et al". O'Neill Institute Healthcare Litigation Tracker. Georgetown University Law Center. Archived from the original on 2024-12-12. Retrieved 2024-12-12.
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