STAT+: Humana used algorithm in ‘fraudulent scheme’ to deny care to Medicare Advantage patients, lawsuit alleges
Medicare Advantage beneficiaries on Tuesday filed a class-action lawsuit alleging that Humana illegally used an algorithm to prematurely cut off payment for rehab care.
Medicare Advantage beneficiaries on Tuesday filed a class-action lawsuit alleging that the health insurance giant Humana illegally used an algorithm to prematurely cut off payment for rehabilitation care after patients suffered serious illnesses and injuries.
The suit, filed in U.S. District Court in Western Kentucky, argues Humana’s reliance on the algorithm, known as nH Predict, was part of a fraudulent scheme to reap a windfall by systematically denying claims to desperately ill people.
It is the second suit filed following a STAT investigation that found Medicare Advantage insurers nationwide are using the algorithm to cut off patients’ rehab care, forcing them to forgo treatment or pay thousands of dollars out of pocket. An earlier complaint was filed in November against the algorithm’s maker, NaviHealth, and the company that owns NaviHealth, UnitedHealth Group.
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