Conspiring to deny a service to someone who paid for it, is a crime, its fraud, its theft. Its like a Reverse Dine-and-Dash, but for healthcare. If I paid for a bagel and you refused to give me such bagel, then you stole my money. Its that simple.
UnitedHealth used an AI model it knew had a 90% error rate to cut off care for elderly patients, and kept using it because almost nobody appeals — that is the allegation at the centre of a class action now in discovery in Minnesota.
When patients did push back more than nine in ten denials were reversed on internal appeal or before a federal administrative law judge. Denials that rarely survived scrutiny, and scrutiny that rarely arrived.
One of the AI's victims is Gene Lokken (91) who broke his leg and ankle in a fall. UnitedHealth covered three weeks of nursing-home rehab, then stopped while his physical therapist's notes still recorded weakness and reduced mobility.
His family paid $12,000 to $14,000 a month out of pocket until he died a year later. His estate is the lead plaintiff.