Humana uses AI to deny elderly patients Medicare care, class action claims

Humana AI class action lawsuit overview: 

• Who: Joanne Barrows and Susan Hagood filed a class action lawsuit against Humana Inc. 
• Why: Barrows and Hagood claim Humana uses an AI model to deny care to elderly patients who have already had a real human doctor determine the care was medically necessary. 
• Where: The class action lawsuit was filed in Kentucky federal court. 

Health insurance company Humana unlawfully deploys artificial intelligence (AI) to wrongfully deny elderly patients care that is owed to them under Medicare Advantage plans, a new class action lawsuit alleges. 

Plaintiffs Joanne Barrows and Susan Hagood claim Humana uses AI in place of human doctors to override live physicians determinations “as to medically necessary care patients require.” 

The plaintiffs argue Humana is aware that predictions made by its AI model, nH Predict, are “highly inaccurate” and “not based on patients’ medical needs,” but still continues using it to deny patients’ coverage anyway. 

“Despite the high rate of wrongful denials, Humana continues to systemically use this flawed AI Model to deny claims,” the Humana class action states. 

The plaintiffs want to represent a nationwide class and multistate subclass of individuals who purchased a Medicare Advantage health insurance plan through Humana during the period of four years prior to the filing of the complaint through the present. 

Humana allegedly aware only ‘tiny minority’ of policyholders will appeal a denied claim

The plaintiffs argue Humana is aware only a “tiny minority” of policyholders will appeal a denied claim, with the majority opting to either pay out of pocket costs or “forgo the remainder of their prescribed post-acute care.” 

“Humana banks on the patients’ impaired conditions, lack of knowledge, and lack of resources to appeal the wrongful AI-powered decisions,” the Humana class action states. 

Being denied care, meanwhile, causes elderly patients to get “prematurely kicked out of care facilities” and forced to choose between depleting their family savings or “forgo care altogether,” the Humana class action alleges. 

Barrows and Hagood claim Humana is guilty of unjust enrichment, breach of contract and breach of the implied covenant of good faith and fair dealing, and of violating the law in multiple states. 

A separate class action lawsuit was filed against Humana in February by a consumer arguing the company placed unlawful pre-recorded promotional messages to individuals who had not consented to receiving them. 

Have you been denied care under Humana’s Medicare Advantage plan? Let us know in the comments.

The plaintiffs are represented by James F. Guilfoyle of Guilfoyle Law Office and Glenn A. Danas, Ryan Clarkson and Zarrina Ozari of Clarkson Law Firm PC. 

The Humana AI class action lawsuit is Barrows, et al. v. Humana Inc., Case No. 3:23-cv-00654, in the U.S. District Court for the Western District of Kentucky.

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