In This Article:
Since the recent shooting of former UnitedHealthcare (UNH) CEO Brian Thompson in New York City, the health insurance provider has been under severe scrutiny. While the motives behind Thompson’s assassination remain unknown, the company is in full focus as the media shines an intense spotlight on its history and operations.
🚨Don’t miss this amazing Cyber Week Move! Get 60% off TheStreet Pro. Act now before it’s gone. 😲
Reports indicate that Thompson, a respected veteran of the health insurance field, had received threats prior to the attack. But as this is fairly common for leaders in his industry, Thompson and his company disregarded them. As of now, very little is known regarding the shooter’s identity or motives.
As details become available, though, reporters have been digging into UnitedHealthcare, the insurance arm of UnitedHealth, providing detailed context on an industry that doesn’t often receive much mainstream focus. One recent discovery highlights something that could be highly concerning for both investors and customers and could have wide-ranging implications.
UnitedHealthcare’s major operational flaw
It’s no secret that artificial intelligence (AI) has taken over many industries. Since the launch of ChatGPT in 2022, companies have rushed to implement AI systems as a means of optimizing production and streamlining efficiency. But in the case of UnitedHealthcare, it seems to have caused some significant problems.
Related: UnitedHealth executive killed in 'targeted attack' in Manhattan
One month before Thompson’s assassination, hospitals began reporting an uptick in denied insurance claims. This prompted speculation that the AI bots being used by insurance providers were responsible. Families of now-deceased patients who UnitedHealthcare denied coverage opted to take legal action.
That’s hardly where it began, though.
A class action lawsuit filed on November 14, 2023, in the US District Court in Minnesota alleged that UnitedHealth Group and its subsidiaries, UnitedHealthcare and Navihealth, were guilty of using AI technology “in place of real medical professionals to wrongfully deny elderly patients care.”
According to the suit, the companies were aware that the AI model had a 90% error rate in evaluating their claims and had overridden the determinations made by both patients’ physicians.
The plaintiffs also accused UnitedHealthcare’s leaders of proceeding with its “flawed AI model” despite knowing its limitations because they also knew only a fraction of policyholders, roughly 0.2%, would appeal their claims, even after being denied the coverage they needed.