Mastodawn

Angela G Apr 10, 2024

Please boost so anyone in the US with #MedicareAdvantage or any #UnitedHealthcare plans, including #Optum and #NaviHealth can read this article on the algorithms they use to deny your care and what it takes to fight back. #HCR4US #HealthcareIsAHumanRight

https://kffhealthnews.org/news/podcast/attack-of-the-medicare-machines/

Attack of the Medicare Machines - KFF Health News

In this episode of “An Arm and a Leg,” host Dan Weissmann tells a horror story. Instead of monsters and aliens, it’s about private health insurance companies and algorithms that call the shots on patient care.

KFF Health News

Georgiann Baldino Dec 15, 2023

"In a class action lawsuit filed Tuesday, plaintiffs argued the payer prematurely cut payments for MA [Medicare Advantage] beneficiaries’ ... #Humana [reportedly] based the cuts on the AI model’s 'rigid and unrealistic predictions for recovery' — not doctors’ recommendations — despite knowing the model’s estimations were often 'highly inaccurate.'
"...another suit [pending] against #UnitedHealth and nH’s owner, #NaviHealth."

Courtesy of Yahoo and HealthCare Dive https://finance.yahoo.com/news/humana-used-algorithm-deny-care-105455153.html

Humana used algorithm to deny care to Medicare Advantage patients, lawsuit claims

The insurer is the latest to be hit with a suit over its use of algorithms to appraise claims.

Yahoo Finance

Benjamin Carr, Ph.D. 👨🏻‍💻🧬Nov 18, 2023

#UnitedHealth uses #AI model with 90% error rate to deny care, #lawsuit alleges
For the largest #healthinsurer in the #US, AI's error rate is like a feature, not a bug. Since UnitedHealth acquired #NaviHealth in 2020, former employees told Stat that the company's focus shifted from #patient advocacy to performance metrics and keeping post-acute care as short and lean as possible but over 90 percent of the #insurance denials are reversed on appeal. https://arstechnica.com/health/2023/11/ai-with-90-error-rate-forces-elderly-out-of-rehab-nursing-homes-suit-claims/

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

For the largest health insurer in the US, AI's error rate is like a feature, not a bug.

Ars Technica

beSpacific Oct 5, 2023

#UnitedHealthcare uses #naviHealth care mgmt bought in 2020 2 help make coverage decisions. Proprietary “nH Predict” tool sifts thru M of #medicalrecords to match patients w similar #diagnoses & characteristics. Based on these comparisons #algorithm anticipates what kind of care specific patient will need, 4 how long and predicts patient’s date of discharge which coincides w insurer cuts off coverage even if the patient needs further treatment #Medicare would provide. https://kffhealthnews.org/news/article/biden-administration-software-algorithms-medicare-advantage/

Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients - KFF Health News

Software sifts through millions of medical records to match patients with similar diagnoses and characteristics and then predicts what kind of care an individual will need and for how long. New federal rules will ensure human experts are part of the process.

KFF Health News

Jen, MPH

Mar 13, 2023

“Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need”

“STAT is investigating denials and appeals in Medicare Advantage, and the role that technology plays in those decisions. If you have an experience with Medicare Advantage denials, please share your story with us.”

#MedicareAdvantage #Medicare #healthInsurance #artificialIntelligence #AI #algorithms #SecurityHealthPlan #NaviHealth #UnitedHealthGroup #UnitedHealthcareAdvantage

https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/