Plaintiffs say Humana profits from AI denial of Medicare Advantage claims

Class-action plaintiffs are accusing health insurance giant Humana of inappropriately profiting from the use of its artificial intelligence model to assess patient claims, arguing the nH Predict AI Model makes “unrealistic” recovery predictions to deny insureds treatment under the Medicare Advantage program.

“The nH Predict AI Model determines Medicare Advantage patients’ coverage criteria in post-acute care settings with rigid and unrealistic predictions for recovery,” say plaintiffs in an April 22 amended complaint filed with the U.S. district court for...