UnitedHealthcare accused of relying on AI algorithms to deny Medicare

Democrats on a Senate subcommittee are accusing UnitedHealthcare Group of denying claims to a growing number of patients as it tried to leverage artificial intelligence to automate the process.

In an October report, “How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care,” Democrats on the U.S. Senate Permanent Subcommittee on Investigations (PSI) released a report claiming UnitedHealthcare’s prior authorization denial rate for post-acute care jumped from 10.9% in 2020 to 22.7% in 2022.

Denial rates for skilled nursing centers, in particular, “experienced particularly dramatic growth.” The number of denied claims in 2022 was nine times higher compared to 2019, according to the report.

During this same period of time, the company “implemented multiple initiatives to automate the process,” according to the report. 

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The report also claimed United “processed far more home health service authorizations for Medicare Advantage members during this period, underscoring concerns about insurers rejecting placements in post-acute care facilities in favor of less costly alternatives,” the report said. 

FOX Business reached out to United for comment. In a statement issued in October, the company lambasted the report, saying it “mischaracterizes the Medicare Advantage program and our clinical practices, while ignoring CMS criteria demanding greater scrutiny around post-acute care.”

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The report surfaced as the largest health insurance company has come under fire for allegedly wrongfully denying claims in recent months. The murder of UnitedHealthcare CEO Brian Thompson in New York on Wednesday prompted more critics to air their frustrations with the company. 

According to the PSI’s report, a UnitedHealthcare committee approved using “Machine Assisted Prior Authorization” to speed up the process of reviewing medical requests in April 2021. The committee was told doctors or nurses still had to verify the evidence, but testing showed the technology could cut review time by 6-10 minutes, the report said.

UnitedHealthcare tested a new “HCE Auto Authorization Model” in early 2021, and internal meeting notes revealed that it produced “faster handle times” for cases. But there was also an increase in the number of cases that were denied due to the system catching errors that were missed in the original review, according to the report. The report said the…