Before the CEO of UnitedHealthcare was killed, a lawsuit had been filed against the insurance giant, accusing the company of using a faulty Artificial Inteligence tool to deny claims that had already been approved by doctors.
In November 2023, a lawsuit filed by two families claimed that UnitedHealthcare used an AI algorithm to deny coverage for patients, despite doctors deeming the care necessary.
Both of the families had a family member that was covered by the insurance giant die, as reported by Newsweek.
"The fraudulent scheme affords Defendants a clear financial windfall in the form of policy premiums without having to pay for promised care, while the elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary medical care, all because an AI model 'disagrees' with their real live doctors' determinations," the lawsuit stated, according to Newsweek.
The lawsuit claimed that UnitedHealthcare knew that the AI tool, developed by NaviHealth, who was also named in the suit, had a "90% error rate," CBS News reported when the lawsuit was first filed.
UnitedHealthcare defended the use of the tool, telling Fierce Healthcare in November 2023 that the "tool is not used to make coverage determinations," but is instead used as a "guide to help us inform providers, families and other caregivers" about future potential needs for the patient.
The lawsuit remains ongoing.
The insurance giant appears to deny claims at almost twice the rate of other insurance companies, according to reports cited by Forbes. Some hospital systems have stopped accepting the company's insurance coverage.
CEO Brian Thompson was shot and killed Wednesday in New York City in a targeted attack, police said. No one has been arrested in connection with the shooting.
The words "deny," "defend" and "depose" were found engraved on the bullets used in the shooting, which many have connected to the book "Deny, Defend, Depose," which criticizes insurance practices. However, a motive has not yet been identified.
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