Seniors Fight Back: Humana Faces Lawsuit for Denying Rehabilitation Care
Published on: March 10, 2024
Health insurer Humana has become the focus of a class-action lawsuit filed Tuesday. The lawsuit claims that the company is utilizing an AI algorithm to systematically deny elderly patients the rehabilitation care recommended by their doctors, a move that could have far-reaching implications in the healthcare sector.
The significance of this lawsuit is underscored by its timing. Humana is now the second major health insurer to face legal repercussions over the alleged misuse of AI tools to restrict necessary medical care for Medicare Advantage patients. Previously, UnitedHealth Group faced a similar lawsuit for using an algorithm developed by its subsidiary, NaviHealth.
This litigation is part of a broader trend of increasing scrutiny on how insurance companies employ AI tools in making coverage decisions. The legal landscape is evolving as regulators attempt to address the complex interplay of technology and healthcare ethics. Earlier this year, Cigna was also accused of using AI algorithms to inappropriately reject claims.
The lawsuit against Humana, filed in a federal court in Kentucky, alleges that the company replaced medical professionals' judgments with an algorithm to deny elderly patients their entitled care under Medicare Advantage plans. The suit contends that the algorithm inaccurately predicts the care needs of elderly patients and that employees are penalized for not adhering to its recommendations.
Detailing the impact of this policy, the lawsuit cites the case of JoAnne Barrows, an 86-year-old woman from Minnesota. After sustaining a leg fracture, Barrows was allegedly denied continued rehabilitation care by Humana, leading to her and her family shouldering the costs for alternative, less effective care.
The plaintiffs argue that Humana's reliance on this 'flawed AI model' for claim denials is a calculated strategy, aware that only a small fraction of policyholders will challenge these decisions. The lawsuit underscores a growing concern about the ethical use of AI in healthcare decision-making and the need for regulatory oversight.