Humana AI failures

Humana was sued over using nH Predict AI to systematically deny Medicare post-acute claims

A class action lawsuit filed on December 12, 2023 alleges that Humana used an AI model called nH Predict, owned by UnitedHealth subsidiary NaviHealth, to override physician determinations and wrongfully deny Medicare Advantage members coverage for post-acute care. The complaint claims Humana set a target to keep post-acute facility stays within 1% of the algorithm's predictions and disciplined employees who deviated. Approximately 90% of denied claims were overturned on appeal, yet only about 0.2% of denied policyholders actually appealed. The Senate Permanent Subcommittee on Investigations published a report in October 2024 scrutinizing Humana and other insurers for AI-driven denials of post-acute care.

Confidence

High (multi-source, primary)