Humana’s Alleged Use of AI to Deny Claims Draws Class Action

Health insurer Humana Inc. is facing a class action alleging it used artificial intelligence to deny elderly patients care, the latest legal action over the use of advanced technology in making care determinations.

Filed in the US District Court for the Western District of Kentucky, the complaint accuses Humana of using AI to override doctors’ recommendations and deny care owed to elderly patients under their Medicare Advantage Plans.

The AI, the lawsuit said, renders predictions Humana knows to be “highly inaccurate,” though the insurer “continues to systemically use this flawed AI model to deny claims because they know that only a tiny minority of policyholders” will appeal.

The class action was filed by Clarkson Law Firm P.C. It follows others that the firm brought earlier this year against UnitedHealthcare and Cigna over allegedly improper use of advanced technology.

Cigna and Humana were previously in merger talks. However, Cigna has since walked away from the talks, Bloomberg reported.

According to the complaint, Humana is using an AI model called “nh Predict.” That AI model is at the center of the UnitedHealthcare lawsuit as well. The AI, according to the Humana lawsuit, is used to make calls on post-acute care coverage criteria “with rigid and unrealistic predictions for recovery.”

Humana has “deliberately failed” in fulfilling its “statutory, common law, and contractual obligations to have a doctor determine individual coverage for post-acute care in a thorough, fair, and objective manner, instead using the nH Predict AI Model to supplant real doctors’ recommendations and patients’ medical needs,” the complaint said.

Among the plaintiffs are a woman over the age of 85 whose coverage for rehabilitation for a leg fracture was allegedly terminated prematurely, and a woman who, along with her family, allegedly incurred more than $24,000 in medical expenses for treatment that Humana denied.