Denied by AI: How big insurers use algorithms to cut off care for Medicare Advantage patients
Following a tip from an employee at a small nursing home, STAT reporters Casey Ross and Bob Herman relied on internal sources, confidential company documents, and court records to reveal how UnitedHealth Group, the nation’s largest health insurer, was inappropriately using predictions from a flawed computer algorithm to deny care to seriously ill patients. Reducing older adults and people with disabilities to numbers, insurers used the predictions to deny or prematurely cut off rehab care of sick and injured Medicare Advantage beneficiaries and maximize the company’s profits. The publication of this four-part investigative series prompted federal regulators to issue new rules and launch their own investigations and triggered at least two class-action lawsuits.
View the story