Class-Action Lawsuit Accuses Humana Of Using AI Algorithms To Restrict Access To Post-Acute Rehabilitation Services

A class-action lawsuit alleges that Humana’s use of an artificial intelligence (AI) algorithm developed by naviHealth resulted in inappropriately denying coverage of rehabilitative services and long-term care. The nH Predict AI Model is intended to project the duration of rehabilitative services needed by a given consumer. The plaintiffs allege that the algorithm is based on “rigid and unrealistic” predictions for recovery and that the predictions were used to override recommendations from the consumer’s treating clinical professionals. As a result of the predictions, Humana Medicare Advantage plans denied requests for longer coverage of rehabilitative care and members . . .