A federal judge ruled that plaintiffs did not need to exhaust administrative appeals, citing the irreparable harm caused by care denials and the futility of the appeal process due to Humana’s alleged tactics of repeatedly denying claims and settling appeals only to restart the denial cycle. The case will proceed with claims for breach of contract, breach of good faith and fair dealing, unjust enrichment, and common law fraud, seeking damages and an injunction to prevent Humana from continuing its AI-driven claim handling practices.
Humana must face a class action lawsuit alleging that its use of artificial intelligence to deny post-acute care to Medicaid Advantage beneficiaries became fraud when those automated decisions replaced the interpretation of clinicians.
Judge Rebecca Grady Jennings of the US District Court for the Western District of Kentucky on Friday ruled that the plaintiffs did not have to exhaust Medicare administrative appeals before filing their complaint in late 2023.
In March, Humana asked the court to dismiss those claims, arguing that the District Court had no jurisdiction because two women initially behind the lawsuit didn’t ask the Quality Improvement Organizations to review their coverage denials first.
Marselas, K. (2025, August 19). Humana must face class action suit over use of AI in denying post-acute care. McKnight’s Long-Term Care News. https://www.mcknights.com/news/humana-must-face-class-action-suit-over-use-of-ai-in-denying-post-acute-care/
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