“This is an example of how AI is being utilized not to help people but to line the pockets of corporations and their shareholders,” Clarkson said.
When these coverage denials are appealed to federal administrative law judges, about 90% are reversed, the complaint said, demonstrating the “blatant inaccuracy” of the algorithm. Only a tiny fraction of patients appeal the denials at all, Clarkson said.
Also, a lawsuit last year was accusing the company of using AI to automatically deny claims - https://www.cbsnews.com/news/unitedhealth-lawsuit-ai-deny-claims-medicare-advantage-health-insurance-denials/ — https://www.reuters.com/legal/lawsuit-claims-unitedhealth-ai-wrongfully-denies-elderly-extended-care-2023-11-14/