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Politics : Formerly About Advanced Micro Devices -- Ignore unavailable to you. Want to Upgrade?

To: Tenchusatsu who wrote (1507669)	12/11/2024 3:48:31 PM
From: Broken_Clock	1 Recommendation Recommended By longz Read Replies (1) \| Respond to of 1571401

I could tell you straight up that UNH's high denial rates have nothing to do with AI, but you wouldn't believe me. "In October, a report from the U.S. Senate Permanent Subcommittee on Investigations showed that the nation’s insurers have been using AI-powered tools to deny some claims from Medicare Advantage plan subscribers. The report found that UnitedHealthcare’s denial rate for post-acute care — health care needed to transition people out of hospitals and back into their homes — for people with Medicare Advantage plans rose to 22.7% in 2022, from 10.9% in 2020. The rise coincides with UnitedHealthcare’s implementation of an AI model called nH Predict, originally developed by naviHealth, a subsidiary of UnitedHealth Group that has since been rebranded. Algorithms like nH Predict can analyze millions of data points to generate predictions and recommendations by comparing patients to others with apparently similar characteristics, according to an article on JAMA Network. However, the article cautions that claims of enhanced accuracy through advanced computational methods are often exaggerated. Both UnitedHealth and Humana are currently facing lawsuits over their use of nH Predict. The suits allege that insurers pressured case managers to follow the algorithm’s length-of-stay recommendations, even when clinicians and families objected. One lawsuit filed last year against UnitedHealth claims that 90% of the algorithm’s recommendations are reversed on appeal. The lawsuit states that UnitedHealthcare wrongfully denied elderly patients care by “overriding their treating physicians’ determinations as to medically necessary care based on an AI model that Defendants know has a 90% error rate.” qz.com