UnitedHealthcare's broken AI denied seniors' medical claims, lawsuit alleges

UnitedHealthcare has been sued for allegedly denying healthcare claims based on a faulty AI model. The lawsuit [PDF], filed Tuesday in federal court in Minneapolis on behalf of the estates of two elderly men, alleges that at least since UnitedHealthcare's 2020 acquisition of post-acute care management firm Navihealth, the US …

[An_Old_Dog]

You Don't Need AI to Defraud Your Customers

...

if (rand() <= FUCKED_PERCENTAGE) print "Computer says, 'No'. Claim denied for case # ", ${casenum} "!";

...

... but it sounds more authoritative/believable-by-the-ignorant-masses if you add in your claim denial letter, "We use AI to help our staff review and evaluate claims."

[Mike 137]

Re: You Don't Need AI to Defraud Your Customers

but it helps, particularly if there's no easy way to verify the reason for its output, to provide plausible deniability of responsibility.

[Snake]

Re: You Don't Need AI to Defraud Your Customers

Is THAT where general corporatespeak got that formula from!? At least when [insert corporation here] uses it next time I know.

[Blackjack]

Re: You Don't Need AI to Defraud Your Customers

[broken AI denied seniors' medical claims, lawsuit alleges]

Broken? More like working as intended.

[Doctor Evil]

This was predicted!

Holy carp!

I've finally gotten around to reading Cory Doctorow's excellent "Radicalized", a collection of 4 science fiction novellas, and the eponymous tale describes exactly this scenario!

Of course, in the book, victims are "radicalized", taking matters into their own hands rather than banding together to launch a class action suit -- but still! Prescient!

(And highly recommended.)

[Michael Wojcik]

Re: This was predicted!

I can't read Doctorow's more political fiction. The plots are so plausible and unjust that I get too angry and have to put the book down. That's what happened to me with Little Brother. It just hits too close to home.

Works like Nineteen Eighty-Four and Brave New World have enough distance for me that I can enjoy them, even if they're reasonable portrayals of oppression. But Little Brother struck too close to home.

It's hard enough reading non-fiction about this sort of thing, which I find I have to do more or less on a daily basis.

[Peter Prof Fox]

Robots in charge?

I'm guessing that most Register readers would say the day when 'robots will take over' is long, long away. This is one step on that road. Not assembly-line type robots wielding anti-tank guns, but cosseted in the hollowed-out volcanoes of corporate giants.

Here is my law: If you as a professional get questioned, possibly in court, then you have to justify your decision. You can't say "the machine told me" or "that's our procedure" and still be a professional. But hey! You are pretending to be a professional with all the appropriate knowledge and judgemental skills... except you're not. So you're a fraud and going to prison.

And another thing. (I come from Britain so I apologise if this is obvious to the US contingent.) How is 'The weird and magic machine that can't be questioned' allowed to fester when it comes to a public service? (Lots of things fester in other places but they're theoretically accountable.)

(And another thing. Nobody on this side of the Atlantic knows who/what United Healthcare is. A government program? A sneaky upstart corporation? Or what? You might know but lots of us don't. Give us a small sentence, just two words even, of alignment.)

[Gene Cash]

Re: Robots in charge?

Yeah, I'm American, so I know "UHC" (as United Healthcare is more widely known here) is an insurance company, but I found it strange that information was omitted.

[blackcat]

Re: Robots in charge?

The only thing UHC insures it its profit. This is a company that simply would not exist without the levels of corruption and cronyism found in the US govt.

Those calling for medicare for all either don't realise that it would simply be outsourced to the likes of UHC resulting in enormous profit OR they actively want that scenario as they are in the pocket of UHC et al.

For some good takes on US healthcare:

https://www.youtube.com/@DGlaucomflecken

[Snake]

Re: UHC

Their profit, corruption and cronyism has not much to do with the US government: a good percentage of the population keeps voting for this, because after all anything else is "socialism!".

I mean, don't you WANT a profit-draining middleman in ALL your business / health transactions?? Certainly anything else, like gasp! single payer, is marching with Stalin!

[blackcat]

Re: UHC

Without basically taking a flamethrower to the current medical system in the USA it is impossible to have a single payer system as they have in parts of Europe.

The profit and corruption is so inbuilt to the system aided in part by the ACA making it harder for small practices to compete.

The NHS is pretty much crap. If you are in imminent danger of death they are pretty good at patching you up but anything long term or preventative just doesn't happen. Look at NHS dentistry, especially for kids. The figures given by the beeb indicated that it was costing the NHS nearly 2k per tooth extraction AND waiting lists were getting on for 12 months.

https://www.bbc.com/news/health-66095984

My local private dentist will do a sedated extraction for about £500.

[Grogan]

Re: UHC

Heheh... it should be considered crooked, but dentists around here (in my area of Ontario, Canada) ask how you are paying. Out of pocket, $80 or $100+ and they'll yank a tooth for you (not general anesthesia though, that's where your 500 pounds comes into play)

However, if it's "Blue Cross" (or similar dental insurance) it will be several hundred dollars.

That's the only time I go, when I can no longer stand a tooth that needs to come out. Dentists don't like that, so you usually have to find another one next time if you don't play their game. They won't flat out refuse you service, but you just won't get an appointment. They'll tell you they are booked up for the next month or something, I've found. Oh well, fuck em... if it gets serious enough (where it's a danger, e.g. non-trivial infection), you can go to the Emergency department at the hospital. We don't pay for that.

[blackcat]

Re: UHC

In the UK most of us have to rely on private dentists. The prices are not too bad. Cheaper than most vet trips with the cat!

I can usually get an appointment within a week. And after breaking a tooth I got in within an hour for a quick drill and fill to tide me over for a few days.

A normal extraction under local is about £80-100.

UK hospitals usually have no emergency dental. Hospitals just don't seem to like dealing with teeth.

[Anonymous Coward]

Re: UHC

That's the only time I go, when I can no longer stand a tooth that needs to come out.

I did that twice, and that was twice too often. It really is is worth paying (in the US) 500~1000 dollars a year for cleaning, checkups, and nipping cavities in the bud.

And brushing after meals and flossing daily. (And avoiding sodas).

And not a cheap dentist either, because they will drill needlessly to pad your bill.

[CrazyOldCatMan]

Re: UHC

Out of pocket, $80 or $100+ and they'll yank a tooth for you (not general anesthesia though, that's where your 500 pounds comes into play)

However, if it's "Blue Cross" (or similar dental insurance) it will be several hundred dollars.

It's like vets in the UK - if you are insured then, mysteriously, the recommended treatments and cost of those treatments goes up. One of the *many* reasons why are 8 pets are not insured (if they could be - most of the cats are over 10 and, as rescues, effectively uninsurable) - we put money into savings every month to help cope with the vets bills, especially the out-of-ordinary ones. Vaccinations, flea/worm treatment are all paid out of the current account.

Owning a pet is not a free option. If you can't afford to look after them then you shouldn't have them.

[Anonymous Coward]

Re: UHC

There IS a way to do it, but no one wants to accept it, and it's a multi-year, multi-step plan, and a good start on that is to expand medicare for everyone, and then expand it further so it covers everything- dental, vision, hearing, mental healthcare, prescriptions, the works.

the system's already in place, we just need to political strength of will to scale it up further.

However, there are groups that want to destroy medicare entirely, because the private healthcare companies are lining the pockets of those groups.

[blackcat]

Re: UHC

I do not see how expanding medicare can do anything other than line the pockets of the huge medical corps at this time. They have a complete stranglehold on US healthcare.

The govt would end up shovelling money into a giant hole as the corps would know full well that the govt would pay pretty much anything they asked.

[DryBones]

Re: UHC

Which is what the Republicans and insurance companies orchestrated, and are quite happy to have you think this is as good as it gets.

It's manifestly false, and much more efficient and affordable healthcare systems around the world demonstrate this.

[Anonymous Coward]

Re: UHC

CA currently effectively has mostly single payer, because the CA state subsidizes Health Insurance, unless your employer offers insurance with your job.

Ironically, CA now allows employers to offer the kind of unreliable insurance that AHCA was meant to eliminate. So employers offer that to low paid employees (typically in the service industry), and employees choose to state insurance instead. But most people have HMO insurance (insurance and medical health company are the same). So HMOs charge whatever they want and CA state has to pay.

That was possible during the bubble, when rich companies paid a lot in taxes. Looking dodgy now though. The problem with AHCA type of single payer is that there is pressure on the heath providers to price reasonably.

If single payer meant the payer paid a percentage (up to some limit), and got to choose freely their doctor and shop for procedures, and pricing was transparent, that would be something.

The whole system is designed to be the opposite of that.

Republicans generally say that's a good thing. Democrats pay lip service, spout "single payer" as a shallow slogan, and pocket the political donations from the insurance companies anyway.

[blackcat]

Re: UHC

"So HMOs charge whatever they want and CA state has to pay"

This is the issue with 'govt pays' as the companies know the govt has deep pockets and really has little choice in paying.

"got to choose freely their doctor and shop for procedures, and pricing was transparent"

These two are probably the biggest problems I see in US healthcare. You would not normally shop for anything without knowing the price beforehand and ideally having some competition. Imagine if Walmart and Target didn't show any prices and once you'd picked which shop you were going to and taken something off the shelf you could not change your mind. No-one would stand for that.

In the UK you can go to a dentist or private medical provider website and usually see guideline pricing, or call them up and ask them, and you can chose which place you want to take your money to.

Obama proudly proclaimed "If you like your doctor.... you can keep em!" and that doesn't appear to have worked :)

[ChoHag]

Re: Robots in charge?

> the day when 'robots will take over' is long, long away

The word you're looking for is "ago".

[Michael Wojcik]

Re: Robots in charge?

Away with thee, usage troll. Away as an adjective indicating temporal distance is well-established English usage.

[TheWeetabix]

Re: Robots in charge?

Yes, and in typical English usage away means in the future, and ago means in the past, which is the point that the post was making. We aren’t approaching that point in the future, we’ve passed it some time ago in the past..

[Mike 125]

Re: Robots in charge?

>the day when 'robots will take over' is long, long away.

The day when 'robots will take over' is long, long, long, very long....................

You don't need a mechanical machine for human lives to be at the whim of AI.

Capitalism:

"An economic and political system in which a country's trade and industry are controlled by private owners for profit."

AI is making short shrift of optimising that. We already see the latest generation of private owners- tech multi-billionaires.

[Mike 137]

Re: Robots in charge?

'You can't say "the machine told me" or "that's our procedure" and still be a professional'

Thousands+ already do, and have done for ages. The application of AI (in the technology sense only) merely provides one more argument for denial of responsibility. Personal responsibility is actively discouraged by most organisations, hence "we take security seriously" after every data breach.

[CrazyOldCatMan]

Re: Robots in charge?

'You can't say "the machine told me" or "that's our procedure" and still be a professional'

Thousands+ already do, and have done for ages.

"Computer says no" has been a comedy trope for *many* years.

[duboce]

Re: Robots in charge?

UnitedHealthcare is the 5th largest (by revenue) corporation in the US and 10th largest on the planet. Fifth only to Walmart, Amazon, Exxon, and Apple. And speaking of healthcare, CVS, your friendly, local drugstore is #6 and #11.

[DJSpuddyLizard]

Re: Robots in charge?

"Medicare Advantage is a privately-run, government-approved attempt to destroy the federal Medicare program "

FTFY.

[Anonymous Coward]

Computer says “No”

That isn’t really new, didn’t need all this fancy “AI” stuff to do that in my day, son.

[lglethal]

No, No, No... The AI is not broken. It's working exactly as specified. It's saving United Healthcare massive amounts of money!

Wait, what? You expected it to help the clients? Don't be silly! That's not what AI is for...

[EricB123]

Incomprehensible!

The following is from the US govt Medicare comparison page.

Medicare, Medicare Advantage, Medigap! Part B and Part D.

This particular benefit is covered in "many", "most" cases. Except when it "generally doesn't".

WTF???

[Michael Wojcik]

Re: Incomprehensible!

It's a puzzle. Health care in the US is gamified for our enjoyment.

[markr555]

US Craziness in action

The US healthcare system, or more appropriately, the lack of it, is truly fucked up!

[Mike 137]

Re: US Craziness in action

"The US healthcare system, or more appropriately, the lack of it, is truly fucked up!"

So is ours in the UK. Whether it's paid for at the point of delivery or not seems to be secondary to it failing.

[Version 1.0]

Re: US Craziness in action

US healthcare was described very accurately by Captain Ska years ago and it's not changed much at all since then!

[MrAptronym]

This was always the plan

While most of us here are typically interested in discussing whether ML models are good at doing useful work, it is not at all surprising that this is how they get implemented. I don't think UHC even want a system that can process and understand complex medical histories: they want a system that reduces payouts, lets them cut staff and gives them plausible deniability though tech obfuscation.

These systems won't be optimized for actual accuracy, because accuracy is not the best outcome for profits. Whatever the training the systems undergo, the actual judgement being made by humans on the system's efficacy is based on profit optimization. It will always end this way.

[Anonymous Coward]

Don't blame the AI algorithm

Don't blame the AI algorithm. All such claims are denied in the hope the applicants won't appeal. On appeal most/all such claims can succeed. Of course if you're experiencing a medical episode, you're in no fit state to appeal .. purr of evil !!

[Kevin McMurtrie]

'murica

Knowing the US healthcare system, I bet the AI was trained to deny payments to patients with the least ability to sue for insurance fraud. Only 2 mistakes in 3 years is pretty solid technology.