A controversial AI program used to deny healthcare coverage to the elderly is now at the center of questions surrounding the shooting of UnitedHealthcare’s CEO.
Brian Thompson, 50, was shot 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, denying one in three claims.
Now it has emerged that the company has implemented AI software in previous years with a denial rate of 90 percent.
According to a lawsuit, the software led to the deaths of at least two elderly men who were left without postal care after a stroke and a fall.
UnitedHealthcare reportedly 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 “deposit” on the shell casing recovered from the murder scene, referring to alleged tactics insurance companies are accused of using to avoid making payouts.
Police are still searching for the man who fatally shot UnitedHealthcare CEO Brian Thompson on Wednesday morning. Some have speculated that the motive could be related to a 2023 lawsuit that claimed the insurer’s “malicious” AI denied 90 percent of claims to elderly patients.
The lawsuit alleged that UnitedHealthcare “relies on patients’ poor conditions, lack of knowledge, and lack of resources to appeal erroneous AI-powered decisions.”
The document continued the use of AI as a ‘fraudulent scheme” that provides the company with 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 that was acquired by UnitedHealth for $2.5 billion in 2020, the lawsuit said.
The software analyzes large data sets of patient medical records, comparing a patient’s data with similar cases in the database to predict future needs and potential outcomes and provide information to health insurers.
The model allegedly provided “general recommendations” that “could not be tailored to a patient’s individual circumstances and violated basic rules about what Medicare Advantage plans must provide,” the lawsuit alleges.
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 from UnitedHealthcare. from at least November 2019 to 2023.
Lokken fell at home and broke his leg and ankle.
He was admitted to the hospital and before being discharged, he was recommended for hospice care as 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, “Additional days of hospitalization in the skilled nursing facility are not medically necessary. A safe discharge plan is recommended.”
The lawsuit alleges 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 were $12,000 to $14,000 per month from July 2022 to July 15, 2023, when he passed away at age 92.
Thompson’s shooter, who has yet to be identified, wrote the words “deny,” “defend” and “deposit” on the shell casing recovered from the murder scene, referring to alleged tactics insurance companies would use to prevent that claims would be paid.
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 never lost sight of a funny or heartfelt event.” story to share’
He worked as an engineer throughout his career and is survived by his wife, brother, five children, twelve grandchildren and four great-grandchildren.
Tetzloff suffered a stroke in October 2022 and was hospitalized where his doctor recommended post-acute care for at least 100 days.
“Tetzloff contacted Defendants to inquire about the reason for the denial of his claim. Defendant declined to provide a reason stating it is confidential,” the lawsuit alleges.
He was forced to pay out-of-pocket expenses of more than $70,000 for approximately ten months until he was discharged to an assisted living facility in June 2023, where he died on October 11, 2023.
He is survived by his wife, three children and seven grandchildren.
And this was “all because an AI model ‘disagreed’ with the determination of their real doctors,” the lawsuit said.
For those who appeal, 90 percent of patient claim denials are reversed, the lawsuit said, adding that “this demonstrates the blatant inaccuracy of the nH Predict AI model and the lack of human review in the coverage denial process .’
The shooter was captured on CCTV at multiple locations, but police have not yet identified him
The gunman shot Thompson at close range outside the Hilton Hotel in Midtown, Manhattan before fleeing north toward Central Park on a bicycle.
Ryan Clarkson, founder of the law firm representing the plaintiffs, previously stated that the class could include tens of thousands of people, and claims for damages could reach billions of dollars.
In May, UnitedHealthcare attorneys argued that the plaintiffs had “failed to exhaust the Medicare Act’s exclusive administrative appeals process” and that the lawsuit should therefore be dismissed, according to Stands.
They believe the issues raised in the lawsuit lie with the federal government, not UnitedHealth or its subsidiaries.
The lawsuit has gained renewed attention in the wake of Thompson’s killing, resurfacing amid a wave of criticism of the company as the public speculates about the shooter’s motive.
Others have criticized these responses as insensitive.
“I just want to remind you that Brian Thompson, the CEO of UnitedHealth who was just shot in New York, was a human being with a family. So many of the responses to his murder are despicable,” Julie Nelson, an anchor at Minnesota news station KARE, wrote in a post on X.
UnitedHealth Group said in a statement that its “hearts are broken” and that it has been “touched by the outpouring of kindness and support.”
“So many patients, consumers, healthcare professionals, associations, government officials and other caring people have taken the time to reach out. We are grateful even as we grieve,” the statement read.
“Our priorities are first and foremost supporting Brian’s family; ensuring the safety of our employees; and work with police to bring the perpetrator to justice.”
“We, at UnitedHealth Group, will continue to be there for those who depend on us for their healthcare,” 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.