AI Doctors Deny Care? Humana Hit with Lawsuit Over Senior Rehab

AI Shadow Doctors? Insurer Accused of Denying Elderly Patients Rehab with Algorithm

Imagine, you’re 86, recovering from a broken leg, doctor’s orders: six weeks bed rest. Enter “Dr. Algorithm,” a cold, calculating AI tool Humana allegedly uses to second-guess medical professionals and deny necessary care like rehab.

This isn’t science fiction, it’s a growing legal nightmare for health insurers. A recent class-action lawsuit accuses Humana of prioritizing profits over people, using this opaque algorithm to systematically deny elderly patients like JoAnne Barrows the rehabilitation they desperately need.

The alleged playbook? Predict how little care an elderly patient requires, tie employee bonuses to meeting these targets, and disregard doctors’ recommendations if they exceed the algorithm’s “budget.” The result? Ms. Barrows, bedridden and catheter-dependent, denied further care and forced into substandard assisted living, only to deteriorate and return home prematurely.


This isn’t an isolated incident. Humana joins UnitedHealth in facing similar lawsuits over the same AI tool. ProPublica reports a Cigna physician using AI to deny over 60,000 claims in a month.

Why the uproar? Congress, regulators, and even a bipartisan Senate panel are raising alarms about AI-driven coverage denials in Medicare Advantage, a popular alternative to traditional Medicare. Lawmakers question why seniors in these plans seem to face more denials than those in traditional Medicare.

The good news? Change is brewing. New federal rules in January will restrict how Medicare Advantage plans use these algorithms. But questions linger: Can algorithms replace doctors’ judgment? Who ensures their accuracy? Is profit trumping patient well-being?

Humana claims their AI is merely “augmented,” with humans still in the loop. But Ms. Barrows’ story paints a different picture.

The fight for transparency and patient-centered care in the age of AI has begun. The question is, will algorithms be doctors’ assistants or gatekeepers to care, leaving seniors like Ms. Barrows caught in the crossfire?

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