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A controversial AI program used to deny elderly people health coverage is now at the center of questions about the shooting of the UnitedHealthcare CEO.
Brian Thompson, 50 was gunned down Wednesday outside a Hilton in Midtown Manhattan in what police have described as a ‘brazen’ and ‘targeted’ attack.
The killer is still on the loose and the motive is not yet known – but a former-FBI agent told Newsweek that he may have been denied health coverage.
UnitedHealthcare became the largest denier of insurance plans in 2023, dismissing one in every three claims.
It has now emerged that during the years before that, the company implemented AI software that had a 90 percent denial rate.
A lawsuit has claimed the software led to the deaths of at least two men who were elderly patients denied post care following a stroke and fall.
UnitedHealthcare is said to have launched the nH Predict AI Model in 2019, with Thompson taking over as CEO in April 2021 – years before the lawsuit was filed.
Thompson’s shooter, who has yet to be identified, wrote the words ‘deny,’ ‘defend’ and ‘depose’ on the shell casing recovered at the murder scene, which refers to alleged tactics insurance companies are accused of using to avoid paying claims.
Police are still searching for the man that fatally shot UnitedHealthcare CEO Brian Thompson on Wednesday morning. Some have speculated that the motive could be tied to a 2023 lawsuit alleging that the insurer’s ‘malicious’ AI denied 90 percent of claims to elderly patients
The lawsuit claimed that UnitedHealthcare ‘banks on the patients’ impaired conditions, lack of knowledge, and lack of resources to appeal the erroneous AI-powered decisions.’
The document continued to blast the use of AI as a ‘fraudulent scheme’ that allows the company a clear financial windfall in the form of policy premiums without having to pay for promised care.’
The nH Predict model was developed by NaviHealth Inc, a Tennessee company acquired by UnitedHealth in 2020 for $2.5 billion, the lawsuit states.
The software analyzes large datasets of patient health records, comparing a patient’s data to similar cases within the database to predict future needs and potential outcomes, providing information to health insurance companies.
The model allegedly provided ‘generic recommendations’ that failed to ‘adjust for a patient’s individual circumstances and conflict with basic rules on what Medicare Advantage plans must cove,’ the lawsuit claims.
The plaintiffs are the families of Gene B. Lokken and Dale Henry Tetzloff, both now-deceased patients who were covered by a Medicare Advantage Plan policy provided by UnitedHealthcare. from at least November 2019 to 2023.
Lokken fell at home and fractured his leg and ankle.
He was admitted to the hospital and before being discharged, he recommended he be admitted to hospice care because his health began to deteriorate.
UnitedHealthcare covered the cost of Lokken’s post-acute care at Thorne Crest Senior Living Community in Albert Lea, Minnesota from July 1, 2022 to July 20, 2022.
When coverage was terminated, the insurance company explained: ‘More inpatient days at the skilled nursing facility are not medically necessary. A safe discharge plan has been recommended.’
The lawsuit claims that ‘medical records submitted to UnitedHealthcare for review indicated that Mr. Lokken was not ready to go home.’
Lokken’s out-of-pocket expenses during his stay at the skilled nursing facility amounted to $12,000 to $14,000 per month from July 2022 until July 15 2023 when he passed away at the age of 92.
Thompson’s shooter, who has yet to be identified, wrote the words ‘deny,’ ‘defend’ and ‘depose’ on the shell casing recovered at the murder scene, which refers to alleged tactics insurance companies are accused of using to avoid paying claims
Gene B. Lokken died on July 15, 2023 at Thorne Crest Senior Living Community in Albert Lea, Minnesota at the age of 92, according to his obituary, which goes on to say that ‘he was never at a loss for a funny or heartfelt story to share’
He worked as an engineer for his entire career and is survived by his wife, brother, five children, 12 grandchildren and four great-grandchildren.
Tetzloff suffered a stroke in October 2022 and was admitted to the hospital where his doctor recommended post-acute care for at least 100 days.
‘Tetzloff contacted Defendants to inquire about the reason for denying his claim. Defendant refused to provide any reason, stating that it is confidential,’ the lawsuit claims.
He was forced to pay out out-of-pocket expenses exceeded $70,000 over approximately ten months until he was discharged in June 2023 to an assisted living facility, where he passed away on October 11, 2023.
He is survived by his wife, three children and seven grandchildren.
And this was ‘all because an AI model ‘disagrees’ with their real live doctors’ determination,’ the lawsuit states.
For those that do appeal, 90 percent of patient claim denials are reversed, the lawsuit stated, adding that ‘this demonstrates the blatant inaccuracy of the nH Predict AI Model and the lack of human review involved in the coverage denial process.’
The shooter was captured on CCTV video in multiple locations, but police have yet to identify him
The gunman shot Thompson at close range outside the Hilton Hotel in Midtown, Manhattan before fleeing northward on a bicycle toward Central Park
Ryan Clarkson, founder of the law firm representing the plaintiffs, previously stated that the class could include tens of thousands of people, and that claims for damages could reach billions of dollars.
In May, UnitedHealthcare’s lawyers argued that the plaintiffs ‘failed to exhaust the exclusive administrative appeal process set by the Medicare Act,’ and therefore the suit should be dropped, according to Stat.
They believe the issues raised in the lawsuit are with the federal government, not UnitedHealth or its subsidiaries.
The lawsuit has received renewed attention in the wake of Thompson’s murder, resurfacing in a wave of scrutiny toward the company as the public speculates about the shooter’s motive.
Others have criticized these reactions as insensitive.
‘Just a reminder that Brian Thompson, the CEO of UnitedHealth who was just shot and killed in NY, was a human being with a family. So many of the comments on his murder are despicable,’ wrote Julie Nelson, an anchor at Minnesota news station KARE, in a post on X.
UnitedHealth Group said in a statement that its ‘hearts are broken’ and that they have been ‘touched by the huge outpouring of kindness and support.’
‘So many patients, consumers, health care professionals, associations, government officials and other caring people have taken time out of their day to reach out. We are thankful, even as we grieve,’ the statement reads.
‘Our priorities are, first and foremost, supporting Brian’s family; ensuring the safety of our employees; and working with law enforcement to bring the perpetrator to justice.’
‘We, at UnitedHealth Group, will continue to be there for those who depend upon us for their health care,’ the statement continued. ‘We ask that everyone respect the family’s privacy as they mourn the loss of their husband, father, brother and friend.’
UnitedHealthcare did not immediately respond to DailyMail.com’s request for comment.
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