Medicine
This is a community for medical professionals. Please see the Medical Community Hub for other communities.
Official Lemmy community for /r/Medicine.
[email protected] is a virtual lounge for physicians and other medical professionals from around the world to talk about the latest advances, controversies, ask questions of each other, have a laugh, or share a difficult moment.
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Related Communities
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See the pinned post in the Medical Community Hub for links and descriptions. link ([email protected])
Rules
Violations may result in a warning, removal, or ban based on moderator discretion. The rule numbers will correspond to those on /r/Medicine, and where differences are listed where relevant. Please also remember that instance rules for mander.xyz will also apply.
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Flairs & Starter Comment: Lemmy does not have user flairs, but you are welcome to highlight your role in the healthcare system, however you feel is appropriate. Please also include a starter comment to explain why the link is of interest to the community and to start the conversation. Link posts without starter comments may be temporarily or permanently removed. (rule is different from /r/Medicine)
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Throwaway accounts: There are currently no limits on account age or 'karma'. (rule is different from /r/Medicine)
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This is the best summary I could come up with:
Humana, one the nation's largest health insurance providers, is allegedly using an artificial intelligence model with a 90 percent error rate to override doctors' medical judgment and wrongfully deny care to elderly people on the company's Medicare Advantage plans.
The lawsuit, filed in the US District Court in western Kentucky, is led by two people who had a Humana Medicare Advantage Plan policy and said they were wrongfully denied needed and covered care, harming their health and finances.
It is the second lawsuit aimed at an insurer's use of the AI tool nH Predict, which was developed by NaviHealth to forecast how long patients will need care after a medical injury, illness, or event.
In November, the estates of two deceased individuals brought a suit against UnitedHealth—the largest health insurance company in the US—for also allegedly using nH Predict to wrongfully deny care.
Humana did not respond to Ars' request for comment by the time this story initially published, but a spokesperson has since provided a statement, emphasizing that there is a "human in the loop" whenever AI tools are used.
In both cases, the plaintiffs claim that the insurers use the flawed model to pinpoint the exact date to blindly and illegally cut off payments for post-acute care that is covered under Medicare plans—such as stays in skilled nursing facilities and inpatient rehabilitation centers.
The original article contains 1,016 words, the summary contains 225 words. Saved 78%. I'm a bot and I'm open source!