UnitedHealthcare’s troubling record of denying claims has been thrust into the spotlight after the insurance giant’s CEO was shot dead in a suspected targeted attack in the heart of Manhattan.
Brian Thompson, 50, was shot outside a Hilton Hotel in Midtown around 6:45 a.m. Wednesday, hours before New Yorkers gathered nearby for the annual Rockefeller Center Christmas tree lighting.
The masked attacker remains at large and has not yet been identified. Their motive for the shooting has not been released.
UnitedHealthcare’s parent company, UnitedHealthcare Group (UHG), has come under fire in recent years from angry patients who claim the insurer refused to cover their care, leaving them out of pocket or struggling without medical care.
UHG is the country’s largest health insurance conglomerate.
In July, more than 150 protesters from the People’s Action Institute campaign group gathered outside UHG’s headquarters in Minnetonka, Minnesota, in what became a fiery demonstration.
Police intervened and arrested 11 people who were later charged with crimes related to blocking the public road outside the building, according to an online clinical publication. Dark daily.
“UnitedHealth Group’s profiteering by denying care is a disgrace, leaving people across Minnesota and the entire United States without the care they desperately need,” activists wrote in a letter to UHG CEO Andrew Witty.
UnitedHealthcare’s parent company, UnitedHealthcare Group (UHG), has come under fire in recent years from angry patients who claim the insurer refused to cover their care, leaving them out of pocket or without medical care. (Pictured: a protest in July)
UnitedHealthcare CEO Brian Thompson was shot dead outside the Hilton Hotel in Manhattan
Witty was also at the Hilton Hotel when Thompson was shot dead. He stopped a meeting there just after 8 a.m. after hearing about the murder of his business partner.
“Health insurance coverage has expanded in America, but we find that it is private health insurers themselves that are often the biggest barrier to people getting the care they and their doctor agree they need,” says protester Aija Nemer-Aanerud, campaign director at the People’s Action Institute, said CBS News in July.
Nemer-Aanerud said UHG leadership has specifically “refused to acknowledge that prior authorization and claim denials are a widespread problem.”
“The safety and security of our employees is a top priority,” UnitedHealthcare said in a statement at the time.
“We have resolved this group’s member-specific concerns and remain open to constructive dialogue on ensuring access to quality, affordable care.”
UnitedHealthcare was also accused of using AI to deny claims for post-acute care services in Medicare Advantage in a lawsuit scheduled earlier this month, according to Fierce healthcare.
The proposed class action was filed by families of two senior Medicare Advantage members who died after the insurer allegedly illegally used the NaviHealth platform to deny care while UHG’s profits soared.
According to the lawsuit, the technology has a 90 percent error rate and the company relies on patient complacency or lack of knowledge about the systems to continue using them.
“Defendants rely on patients’ poor conditions, lack of knowledge, and lack of resources to appeal erroneous AI-powered decisions,” they said in the lawsuit.
In July, more than 150 protesters from the People’s Action Institute campaign group gathered outside UHG’s headquarters in Minnetonka, Minnesota, in what became a fiery demonstration.
UnitedHealthcare’s parent company, UnitedHealthcare Group (UHG), has come under fire in recent years from angry patients who claim the insurer refused to cover their care. Many organized protests, such as the above demonstration in Minnesota in April
In a statement to Fierce Healthcare, UnitedHealth said the lawsuit “had no merit whatsoever” because it did not use NaviHealth to make coverage decisions.
“The NaviHealth prediction tool is not used to make coverage determinations,” a spokesperson said.
‘The tool is used as a guide to help us inform caregivers, families and other caregivers about the type of assistance and care the patient needs, both in the facility and after returning home.
“Coverage decisions are based on CMS coverage criteria and membership plan terms.”
This is evident from a recent study into the company by Stat newsInternal documents showed that NaviHealth had set a 2023 goal of keeping rehabilitation stays for patients in Medicare Advantage plans within 1 percent of the algorithm’s projected days.
Former employees said they were forced to comply with this rule, facing disciplinary action or even termination, regardless of whether the extra days were justified under Medicare coverage rules.
The performance goal was part of a broader effort to reduce nursing home costs for older patients on privatized Medicare plans, Stat News reported.
The paper cited disturbing case studies of patients, including an elderly woman partially paralyzed by a stroke who was reportedly allocated only 20 days of rehabilitation by the algorithm – less than half of the average.
Another case study includes a 78-year-old, legally blind man with failing heart and kidneys, who was given only 16 days in a nursing home.
DailyMail.com has contacted UHG for comment on all the above allegations.
Pictured: People’s Action protesters target health insurer UnitedHealth Group over exorbitant health insurance costs and insurance claim denials on April 16, 2024
There was a large police presence on the scene on Wednesday morning. The NYPD has not yet released a motive
It comes as CEO Thompson was fatally shot in the chest and leg in a targeted attack by a masked man, who then fled on a bicycle down 6th Avenue.
The NYPD has launched a massive manhunt to catch the killer, who is believed to have escaped to Central Park.
Witnesses said the suspected gunman was waiting outside the hotel before the shooting, and that he knew which door Thompson would be coming out of before shooting him at close range.
The CEO was taken to Mount Sinai Hospital in critical condition and was later pronounced dead.
Thompson was named CEO of UnitedHealthcare in 2021, reportedly making $10 million a year, and for several years before that led the Medicare business within UnitedHealthcare.
He was scheduled to speak at an investor meeting at the Hilton Hotel shortly after the shooting. According to one edition of United Healthcare, he was scheduled to announce the company’s hugely profitable financial outlook for 2025 on Tuesday, including projected revenues of more than $450 billion.
The suspect is on the run and is described as a white male wearing a cream-colored jacket, a black face mask, black and white sneakers and a gray backpack.
Thompson was named CEO of UnitedHealthcare in 2021 and reportedly earned $10 million per year. He is survived by his wife, Paulette “Pauley” Thompson, 51, and their two children, who live in the family’s $1.5 million home in Maple Grove, Minnesota.