Health Insurance AI-Based Claim Denials Lawsuit

This cutting-edge class action lawsuit takes aim at the burgeoning use of artificial intelligence in healthcare decisions. The suit alleges that a major health insurer utilized an AI algorithm with a known high error rate to systematically deny claims for post-acute care for elderly patients, such as stays in skilled nursing facilities.

According to the complaint, the AI model was used to override the recommendations of treating physicians and prematurely end care for vulnerable patients in order to cut costs. Plaintiffs argue that this practice violates the insurer's fiduciary duties and state insurance laws, putting profits ahead of patient well-being by relying on a flawed algorithm to make critical medical coverage decisions. The case could have significant implications for how AI is regulated in the healthcare industry.