The fatal shooting of UnitedHealthcare CEO Brian Thompson on Wednesday, which New York police called “brazen” and “targeted,” occurred after the insurer faced legal scrutiny of its cover.
Police have yet to make an arrest in the downtown Manhattan shooting, and the motive remains unclear. The shooting sparked a range of reactions, with many critics not entirely sympathetic, pointing out that the company had refused to cover some patients. Others, however, have called the reactions insensitivity, saying murder is not justified and acts of violence must be denounced.
One criticism of UnitedHealthcare that gained attention after the shooting concerns a lawsuit alleging the company uses artificial intelligence (AI) to deny coverage to some elderly patients who have a Medicare Advantage plan, even though it is allegedly aware that the algorithm has an error of 90 percent. rate.
The lawsuit was filed on November 14, 2023. It names UnitedHealth Group, UnitedHealthcare and NaviHealth as defendants. It was brought by the families of two now-deceased patients who were denied coverage by UnitedHealthcare for their nursing home stays. The lawsuit is ongoing and his allegations have not been proven in court.
News week has contacted UnitedHealthcare by email for comment.
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What the UnitedHealthcare AI lawsuit alleges
The lawsuit alleges that the provider continues to use the system because it knows that only about 0.2 percent of policyholders will appeal their denied claims and that the majority “will either pay out of pocket or forgo the remainder of care prescribed post-acute”. “
The suit says UnitedHealthcare is banking “on patients’ health conditions, lack of knowledge, and lack of resources to appeal flawed AI-based decisions.”
It continues: “The fraudulent scheme offers defendants an obvious financial windfall in the form of insurance premiums without having to pay for promised care, while elderly people are prematurely kicked out of care facilities across the country or forced to depleting family savings to continue to receive necessary medical care. care, all because an AI model “disagrees” with the determinations of their real doctors. »
The suit says an AI model was used to compare a patient’s diagnosis, age, living conditions and physical function to similar patients to predict the person’s needs, estimated duration of stay and the target date of discharge from care establishments.
This model, however, would have provided “generic recommendations” that did not “tailor a patient’s individual circumstances and did not conflict with the basic rules about what Medicare Advantage plans must cover,” according to the suit. .
UnitedHealth group’s response to this lawsuit
In May, lawyers for UnitedHealth Group argued that the suit should be dropped because the plaintiffs “failed to exhaust the exclusive administrative appeal process provided by the Medicare law,” the Stat website reported. They said the issues raised in the lawsuit concern the federal government, not UnitedHealth or its subsidiaries.
For example, the lawsuit alleged that patients were “rarely” in a nursing home for more than two weeks before they began receiving payment denials, despite Medicare Advantage plans allowing patients hospitalized for three days to get up to to 100 days of hospitalization. a retirement home.
The lawsuit also states that more than 90 percent of those denials that are appealed are ultimately overturned.
Some in the healthcare industry are concerned about the use of AI in insurance. A News week The report found that concerns are particularly prevalent among patients with Medicare Advantage plans, which are provided by private insurance companies with contracts with the federal government.
The lawsuit against AI is among examples of the scrutiny UnitedHealthcare is facing following the fatal shooting of its CEO. But while some critics cite the trial after the shooting, or even joke about it, others consider such reactions crude.
“Just a reminder that Brian Thompson, the CEO of UnitedHealth who was just shot and killed in New York, was a human being with a family. Many of the comments about his murder are despicable,” wrote Julie Nelson, anchor of Minnesota News. KARE station, in a message on X (formerly Twitter).
UHC CEO shooting: What we know
The suspect in the Thompson shooting remained at large Thursday afternoon, with police releasing their clearest photo of him more than 24 hours after the shooting.
“UPDATE: Below are photos of a person of interest sought for questioning in connection with the Midtown Manhattan homicide on December 4. This does not appear to be a random act of violence; all indications are that it “This was a targeted (premeditated) attack,” the New York Police Department (NYPD) wrote in a message to X.
🚨UPDATE: Below are photos of a person of interest wanted for questioning in connection with the Midtown Manhattan homicide on December 4th. This does not appear to be a random act of violence; everything indicates that it was a premeditated and targeted attack.
The comprehensive investigative efforts of… pic.twitter.com/K3kzC4IbtS
– NYPD NEWS (@NYPDnews) December 5, 2024
Thompson, 50, was shot near the Hilton Hotel in midtown Manhattan around 6:45 a.m. Wednesday, police said. A masked suspect fled the scene into a nearby alley, then fled on an electric bike toward Central Park.
Thompson was transported to Mount Sinai Hospital, where he was pronounced dead. He was scheduled to speak at an investor presentation at the Hilton later in the day for UnitedHealthcare, the largest private health insurer in the United States. He has been CEO of the company since 2021.
Authorities said Thursday that a bullet found at the scene of the shooting bore the words deny, defend And depositABC News reported.
New York Police Commissioner Jessica Tisch told reporters at a news conference Wednesday that the suspect was “waiting” for several minutes before the shooting.
“Many people encountered the suspect, but he appeared to be waiting for his target. I want to be clear: at this time, everything indicates that this was a premeditated, planned and targeted attack,” he said. she declared.
In a statement, UnitedHealth Group said the company was “deeply saddened and shocked” by the shooting.
“Brian was a highly respected colleague and friend to all who worked with him. We work closely with the New York Police Department and ask for your patience and understanding during this difficult time. Our hearts go out to the family of Brian and all his loved ones for him,” the statement said.