“Lever Time” Presents: Artificial Intelligence Is Denying Americans Health Care
Dec 22, 2023
auto_awesome
Healthcare journalist Bob Herman joins Lever Time to discuss how UnitedHealth Group, the largest health insurer in the US, uses artificial intelligence to deny rehabilitation services to older and disabled Americans. They dive into the impact of this issue, challenges faced by patients, the use of AI in denying health insurance claims, overcharging and abuse in Medicare Advantage plans, and the influence of the insurance industry on the healthcare system.
The largest health insurer in the United States, UnitedHealth Group, has been using artificial intelligence to deny rehabilitation services to older and disabled Americans enrolled in Medicare Advantage health insurance plans.
The use of AI technology in the healthcare industry raises concerns about the lack of personalized care it provides and the systematic overbilling by insurers, including Medicare Advantage plans, which overcharge taxpayers by up to $140 billion per year.
Deep dives
Private health insurance companies are using AI to deny healthcare coverage
In this episode, the use of artificial intelligence and computer algorithms by private health insurance companies to deny healthcare coverage is discussed. Journalists Bob Herman and Andrew Perez from STAT News interview Bob Herman regarding his report on how UnitedHealth, the largest health insurer in the country, utilizes AI to deny rehabilitation services to older and disabled patients enrolled in privatized Medicare Advantage health plans. The algorithm used by UnitedHealth predicts how long a patient should stay in a nursing home, leading to denials of coverage based on cost-saving strategies. The appeals process for patients is complex and difficult, with many individuals unable to navigate it, resulting in them either paying out of pocket for necessary care or being discharged in potentially unsafe conditions.
Class action lawsuit filed against UnitedHealth for denying rehab care
A class action lawsuit has been filed against UnitedHealth and its subsidiary Navi Health accusing them of illegally using an algorithm to deny rehabilitation services to seriously ill patients. The lawsuit alleges that the algorithm has a 90% error rate and that the denial of care disproportionately affects vulnerable individuals who require longer periods of care and recovery. The appeals process for patients is arduous, and although patients have higher success rates when they do appeal, the complexity of the process often deters them from pursuing it. The lawsuit brings attention to the widespread issue of insurance companies using AI to deny claims in bulk.
Concerns about the use of AI in healthcare
The use of AI technology in the healthcare industry raises concerns about the lack of personalized care it provides. While AI is often touted as a tool to deliver individualized care, its use in making cookie-cutter decisions about coverage and denying claims undermines this promise. Additionally, there are reports of systematic overbilling by insurers, including Medicare Advantage plans, which are overcharging taxpayers by up to $140 billion per year. The inherent profit incentives of the insurance industry have led to a system where insurers receive excess payments while simultaneously denying services to patients.
Challenges in enforcing regulations and reforming the system
Enforcement of regulations in the health insurance industry, particularly Medicare Advantage plans, falls under the jurisdiction of the Centers for Medicare and Medicaid Services (CMS). While CMS has taken steps to address abuses and overpayments, its enforcement has been criticized for not being robust enough. However, Congress plays a crucial role in implementing wholesale changes to the system. The insurance industry's financial resources and bipartisan support for Medicare Advantage plans make it challenging to enact significant reforms. Efforts to rein in abuse and overbilling by insurance companies require a multifaceted approach involving both government agencies and legislative action.
Today, we’re sharing an episode of the podcast “Lever Time” from our friends at the reader-supported investigative news outlet The Lever.On this week’s episode of “Lever Time,”Leverproducer Frank Cappello and senior editor and reporter Andrew Perez are joined by health care journalist Bob Herman, who recently co-authored a report for the health care industry news organization STATdetailing how the country’s largest health insurer has used artificial intelligence to deny rehabilitation services for older and disabled Americans.
The insurer, UnitedHealth Group, has claimed that its algorithm, which predicts how long patients will require rehab services, is used solely as a recommendation. But its subsidiary’s case managers allege the company pressures them to adhere to the algorithm’s suggestions in order to cut off payments as quickly as possible. This issue is affecting Americans enrolled in Medicare Advantage health insurance plans, the privatized version of Medicare operated by private insurers as an alternative to traditional Medicare.
“Lever Time”is available on all major podcast players. You can also check out The Lever’s original investigative reporting over at LeverNews.com, and make sure to subscribe to their free newsletter.
If you like Deconstructed, be sure to search for “Lever Time” on your podcast player to subscribe.