Humana wants Medicare Advantage AI lawsuit thrown out

Humana is seeking to dismiss a class action lawsuit alleging the insurer used an AI algorithm to wrongfully deny Medicare Advantage beneficiaries care. 

Lawyers for the Louisville, Ky.-based insurer filed a motion to dismiss the case in U.S. District Court in the Western District of Kentucky March 20. 

In the filing, lawyers argued the plaintiffs in the case had not fully exhausted all of their appeal options and are using a "patchwork" of state laws to bring the case, rather than federal Medicare standards. 

The lawsuit was filed in December by two Humana Medicare Advantage beneficiaries, who alleged the company used nH Predict, an AI tool, to deny coverage for post-acute care. 

UnitedHealth Group owns nH predict and is facing a similar lawsuit alleging wrongful denials of care. The tool is not used to make coverage determinations, a spokesperson for UnitedHealth's Optum told Becker's in November. 

"The tool is used as a guide to help us inform providers, families and other caregivers about what sort of assistance and care the patient may need both in the facility and after returning home," the spokesperson said. "Coverage decisions are based on CMS coverage criteria and the terms of the member's plan." 

In the motion to dismiss, Humana's lawyers called the lawsuit "heavily copied-and-pasted from a similar action filed by the same law firm against another Medicare Advantage Organization." 

A spokesperson for Humana told Becker's the company will "vigorously defend against the lawsuit's baseless allegations of any wrongdoing." 

"If this case were to proceed past the initial motion to dismiss, the facts will show that the complaint's allegations that Humana uses artificial intelligence tools to make adverse coverage determinations without human intervention or oversight have no merit," the spokesperson told Becker's March 22. "Further, the coverage determinations at issue in this case were reviewed and upheld at every level of administrative review that the named Plaintiffs sought." 

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