A November 2023 lawsuit charged UnitedHealthcare with using an AI algorithm, known as nH Predict, that not only denied and overrode claims to elderly patients that had been approved by their doctors but carried a staggering 90% error rate.
AI is going to “amplify what is already working well and it is going to exacerbate what is not working well,” in health care and insurance, Sheila Phicil, CEO of Phicil-itate Change LLC, said in an email. “UnitedHealthcare has used AI to do some good as it relates to identifying and addressing social determinants of health. Those same AI tools resulted in mass denials of patient care, overriding medical professionals’ judgement. It is truly a double-edged sword.”
In addition to paying attention to regulation around the uses of AI, she said, there must also be an understanding and discussion of the systems that are already designed to produce “unjust results.”
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