If proven true, the suit suggests widespread practices that prioritize cost savings over patient needs and directly threaten a nursing home’s ability to provide appropriate care and secure proper reimbursement. This highlights the need for nursing homes to scrutinize Medicare Advantage contracts, advocate for their residents’ needs, and potentially participate in industry efforts to ensure algorithms used in utilization review processes are transparent, fair, and prioritize patient outcomes over profit motives.
Two skilled nursing patients filed a class action suit against Humana Tuesday — alleging their Medicare Advantage benefits were cut prematurely short because of Humana’s wrongful reliance on artificial intelligence.
The lawsuit alleges that Humana regularly overrides clear post-acute care needs and the recommendations of doctors in order to cut costs.
“This putative class action arises from Humana’s illegal deployment of artificial intelligence (AI) in place of real doctors to wrongfully deny elderly patients care owed to them under Medicare Advantage Plans,” the suit states. “Humana knows that the nH Predict AI Model predictions are highly inaccurate and are not based on patients’ medical needs but continues to use this system to deny patients’ coverage.”
The lawsuit was filed Tuesday in the US District Court in Western Kentucky. It is the newest front in a war over the future of AI in healthcare.
Henreckson, J. (2024, April 18). Class action suit targets Medicare Advantage insurer’s use of AI to end rehab stays – McKnight’s Long-Term Care News. McKnight’s Long-Term Care News. https://www.mcknights.com/news/class-action-suit-targets-medicare-advantage-insurers-use-of-ai-to-end-rehab-stays/
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
