CMS’ Medicare Benefit Policy Manual
The Medicare Benefit Policy Manual is published online by the U.S. Centers for Medicare & Medicaid Services, or CMS. Its used by health care providers, contractors, Medicare Advantage companies and…
The lawsuit is progressing through the judicial process and the latest updates are included here.
A class action lawsuit was filed in November 2023 against UnitedHealth Group and a subsidiary alleging that they are illegally using an algorithm to deny rehabilitation care to seriously ill patients, even though the companies know the algorithm has a high error rate.
The case centers on UnitedHealth’s alleged disregard for older adults’ healthcare needs and highlights broader concerns about the use of AI in denying care within Medicare Advantage plans offered by various health insurance providers. The court has allowed the case to proceed with reduced claims, potentially reopening the discovery process to examine UnitedHealth’s AI practices.
The class action suit, filed on behalf of deceased patients who had a UnitedHealthcare Medicare Advantage plan and their families by the California-based Clarkson Law Firm, follows the publication of a STAT investigation. The investigation, cited by the lawsuit, found UnitedHealth pressured medical employees to follow an algorithm, which predicts a patient’s length of stay, to issue payment denials to people with Medicare Advantage plans. Internal documents revealed that managers within the company set a goal for clinical employees to keep patients rehab stays within 1% of the days projected by the algorithm.
Siddiqi, Z., (2025, February 14). Lawsuit against UnitedHealth over AI-Based denials of Post-Acute care moves ahead. Skilled Nursing News. https://skillednursingnews.com/2025/02/lawsuit-against-unitedhealth-over-ai-based-denials-of-post-acute-care-moves-ahead/
Herman, B. (2025, February 6). Class action suit over UnitedHealth’s AI care denials nears key moment. (link has a paywall) STAT. https://www.statnews.com/2025/02/07/unitedhealth-class-action-lawsuit-ai-care-denials-nears-key-decision/
Ross, C., & Herman, B. (2023, December 12). UnitedHealth faces class action lawsuit over algorithmic care denials in Medicare Advantage plans. (link has a paywall) STAT. https://www.statnews.com/2023/11/14/unitedhealth-class-action-lawsuit-algorithm-medicare-advantage/
Gain clarity on the Medicare Advantage payer rates and contract terms bogging down your team and affecting reimbursements.
