Humana Faces Class-Action Lawsuit for Misuse of Algorithm

INSURANCE COMPANY GREED –

Dec. 13, 2023 – Besides the premature termination of rehab care, Humana is also accused of using artificial intelligence (AI) to deny elderly patients the care they were owed under their Medicare Advantage Plans. The AI was allegedly used to override doctors’ recommendations, resulting in a lack of necessary care for elderly patients. Despite claims that the AI model used by Humana renders highly inaccurate predictions, the insurer has continued to use it to deny claims.

Humana’s Legal Battles and Medicare Overcharges

The current lawsuit isn’t the first legal battle involving Humana and Medicare Advantage. In an unrelated case, Humana sued the U.S. government over a Biden administration policy that could allow Medicare to reclaim billions of dollars from insurers for overcharges. The policy allows the government to recoup payments when audits uncover charges for diagnoses not found in patients’ medical records. While the administration believes this could help collect as much as $4.7 billion over 10 years, Humana deems the rule ‘arbitrary and capricious’ and argues that it poses unpredictable consequences for Medicare Advantage organizations.

Medicare Advantage Overpayments and Audits

Overcharges in Medicare Advantage plans are a significant issue. Office of Inspector General (OIG) audits have found over $213 million in estimated Medicare Advantage overpayments in 2023 alone. Between April and September 2023, the agency issued 65 audits, expecting to recover $82.7 million. HumanaChoice, among other plans, was audited and found to have received significant overpayments in previous years.