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By Staff Reporters
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A class action lawsuit has been filed in Minnesota against UnitedHealth Group (NYSE:UNH) over allegations that the health insurer and its subsidiary, NaviHealth, used a faulty algorithm to deny rehabilitation care for Medicare Advantage beneficiaries. California-based Clarkson Law Firm filed the lawsuit in the U.S. District Court of Minnesota on Tuesday following an investigative report published by the health-focused news site Stat.
It alleges that UnitedHealth and its subsidiary, NaviHealth, used the computer algorithm named nH Predict to “systematically deny claims” of patients recovering from debilitating illnesses in nursing homes. According to the lawsuit, despite its 90% error rate, the company used the algorithm to deny claims, knowing that only 0.2% would appeal its decision. According to Stat, Humana (HUM), the nation’s second-largest player in the Medicare Advantage market behind UnitedHealth (UNH), also uses nH Predict. UnitedHealth (UNH) denied it used the NaviHealth predict tool to arrive at coverage decisions.
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Ironically, UnitedHealth’s (NYSE:UNH) Optum Rx unit announced Thursday plans to move eight insulin products to “preferred” status on formularies to further expand the number of patients benefiting from $35 or less monthly out-of-pocket costs for the lifesaving therapy.
Optum Rx, UNH’s pharmacy benefit manager (PBM), said that effective January 1, 2024, all short- and rapid-acting insulins will move to Tier 1 in commercial formularies, a list of drugs the company maintains to indicate coverage for insured patients.
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Filed under: "Doctors Only", Alternative Investments, Drugs and Pharma, Ethics, Financial Planning, Funding Basics, Glossary Terms, Health Economics, Health Insurance, Investing, Marcinko Associates, Touring with Marcinko | Tagged: HUM, Humana, insulin, Marcinko, Medicare Advantage, Medicare C, NASDAQ, NaviHealth, Optum Rx, Part C, PBM, Pharmacy Benefit Mangers, RUT, S&P 500, STAT, stock markets, UNH |
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