nH Predict
{{Short description|Computer program developed by naviHealth}}
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nH Predict is a computer program developed by naviHealth that implements an algorithm that has allegedly been used by health insurance companies including United Healthcare and Humana{{cite web |author=Mole |first=Beth |date=8 February 2024 |title=AI cannot be used to deny health care coverage, feds clarify to insurers |url=https://arstechnica.com/science/2024/02/ai-cannot-be-used-to-deny-health-care-coverage-feds-clarify-to-insurers/ |publisher=Ars Technica}}{{Cite web |title=AIAAIC - NaviHealth nH Predict post-acute care predictions |url=https://www.aiaaic.org/aiaaic-repository/ai-algorithmic-and-automation-incidents/navihealth-nh-predict-post-acute-care-predictions |access-date=2024-12-06 |website=www.aiaaic.org |language=en-US |archive-date=2024-10-04 |archive-url=https://web.archive.org/web/20241004180446/https://www.aiaaic.org/aiaaic-repository/ai-algorithmic-and-automation-incidents/navihealth-nh-predict-post-acute-care-predictions |url-status=live }} to automatically deny coverage to patients.{{cite web|url=https://jamanetwork.com/journals/jama-health-forum/fullarticle/2816204|title=Denial—Artificial Intelligence Tools and Health Insurance Coverage Decisions|date=7 March 2024|author=Michelle M. Mello, Sherri Rose|publisher=JAMA Forum|access-date=6 December 2024|archive-date=7 December 2024|archive-url=https://web.archive.org/web/20241207081524/https://jamanetwork.com/journals/jama-health-forum/fullarticle/2816204|url-status=live}}{{Cite web |last=Al-Sibai |first=Noor |date=December 5, 2024 |title=Murdered Insurance CEO Had Deployed an AI to Automatically Deny Benefits for Sick People |url=https://www.yahoo.com/news/murdered-insurance-ceo-had-deployed-175638581.html |website=Yahoo News |access-date=December 6, 2024 |archive-date=December 6, 2024 |archive-url=https://web.archive.org/web/20241206002119/https://www.yahoo.com/news/murdered-insurance-ceo-had-deployed-175638581.html |url-status=live }}{{Cite web |last=Stanton |first=Andrew |date=December 5, 2024 |title=A year before CEO shooting, lawsuit alleged UHC used AI to deny coverage |url=https://www.newsweek.com/united-healthcare-ceo-shooting-ai-lawsuit-1996266 |website=Newsweek |access-date=December 6, 2024 |archive-date=December 6, 2024 |archive-url=https://web.archive.org/web/20241206015258/https://www.newsweek.com/united-healthcare-ceo-shooting-ai-lawsuit-1996266 |url-status=live }} It is reported to work by cross-correlating patient health records with those of other patients.{{Cite web |last=Jaffe |first=Susan |date=2023-10-05 |title=Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients |url=https://kffhealthnews.org/news/article/biden-administration-software-algorithms-medicare-advantage/ |access-date=2024-12-06 |website=KFF Health News |language=en-US |archive-date=2024-12-06 |archive-url=https://web.archive.org/web/20241206021142/https://kffhealthnews.org/news/article/biden-administration-software-algorithms-medicare-advantage/ |url-status=live }} The software allegedly has a 90% error rate.{{Cite web|url=https://futurism.com/neoscope/united-healthcare-claims-algorithm-murder|title=Murdered Insurance CEO Had Deployed an AI to Automatically Deny Benefits for Sick People|date=December 5, 2024|website=Futurism|access-date=December 6, 2024|archive-date=December 6, 2024|archive-url=https://web.archive.org/web/20241206012004/https://futurism.com/neoscope/united-healthcare-claims-algorithm-murder|url-status=live}}{{Cite web |last=Mole |first=Beth |date=2023-11-16 |title=UnitedHealth uses AI model with 90% error rate to deny care, lawsuit alleges |url=https://arstechnica.com/health/2023/11/ai-with-90-error-rate-forces-elderly-out-of-rehab-nursing-homes-suit-claims/ |access-date=2024-12-06 |website=Ars Technica |language=en-US |archive-date=2024-12-06 |archive-url=https://web.archive.org/web/20241206020814/https://arstechnica.com/health/2023/11/ai-with-90-error-rate-forces-elderly-out-of-rehab-nursing-homes-suit-claims/ |url-status=live }}
It is estimated that such software automates away 50–75% of human labor that would be involved in such tasks.{{Cite web|url=https://www.cbsnews.com/amp/news/unitedhealth-lawsuit-ai-deny-claims-medicare-advantage-health-insurance-denials/|title=UnitedHealth uses faulty AI to deny elderly patients medically necessary coverage, lawsuit claims - CBS News|date=November 20, 2023|website=www.cbsnews.com}}
A class action lawsuit (Estate of Gene B. Lokken et al. v. UnitedHealth Group, Inc. et al.) was filed in November 2023 against UnitedHealth Group regarding use of this software.{{Cite journal |last=Talia |first=Domenico |date=July 2024 |title=Algorithms That Can Deny Care, and a Call for AI Explainability |url=https://ieeexplore.ieee.org/document/10574502/ |journal=Computer |volume=57 |issue=7 |pages=109–112 |doi=10.1109/MC.2024.3387012 |issn=0018-9162|url-access=subscription }}{{Cite web |title=Lawsuit Filed Against UnitedHealth Group, Subsidiary for Use of AI to Deny Care |url=https://www.wha.org/vv-11-16-2023/1 |access-date=2024-12-06 |website=wha.org |archive-date=2024-08-08 |archive-url=https://web.archive.org/web/20240808002504/https://wha.org/vv-11-16-2023/1 |url-status=live }}{{Cite web| title= Estate of Gene B. Lokken et al. v. UnitedHealth Group, Inc. et al.| url= https://litigationtracker.law.georgetown.edu/litigation/estate-of-gene-b-lokken-the-et-al-v-unitedhealth-group-inc-et-al/| website= O'Neill Institute Healthcare Litigation Tracker| publisher= Georgetown University Law Center| access-date= 2024-12-12| archive-date= 2024-12-12| archive-url= https://web.archive.org/web/20241212163400/https://litigationtracker.law.georgetown.edu/litigation/estate-of-gene-b-lokken-the-et-al-v-unitedhealth-group-inc-et-al/| url-status= live}} UnitedHeath Group have stated that the lawsuit is unjustified.