UnitedHealth faces class action lawsuit over algorithmic care denials in Medicare Advantage plans

Casey Ross and Bob Herman

Statnews.com

Originally posted 14 Nov 23

A class action lawsuit was filed Tuesday against UnitedHealth Group and a subsidiary alleging that they are illegally using an algorithm to deny rehabilitation care to seriously ill patients, even though the companies know the algorithm has a high error rate.

The class action suit, filed on behalf of deceased patients who had a UnitedHealthcare Medicare Advantage plan and their families by the California-based Clarkson Law Firm, follows the publication of a STAT investigation Tuesday. The investigation, cited by the lawsuit, found UnitedHealth pressured medical employees to follow an algorithm, which predicts a patient’s length of stay, to issue payment denials to people with Medicare Advantage plans. Internal documents revealed that managers within the company set a goal for clinical employees to keep patients rehab stays within 1% of the days projected by the algorithm.

The lawsuit, filed in the U.S. District Court of Minnesota, accuses UnitedHealth and its subsidiary, NaviHealth, of using the computer algorithm to “systematically deny claims” of Medicare beneficiaries struggling to recover from debilitating illnesses in nursing homes. The suit also cites STAT’s previous reporting on the issue.

“The fraudulent scheme affords defendants a clear financial windfall in the form of policy premiums without having to pay for promised care,” the complaint alleges. “The elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary care, all because an [artificial intelligence] model ‘disagrees’ with their real live doctors’ recommendations.”

The info is here.

Here are some of my concerns:

The use of algorithms in healthcare decision-making has raised a number of ethical concerns. Some critics argue that algorithms can be biased and discriminatory, and that they can lead to decisions that are not in the best interests of patients. Others argue that algorithms can lack transparency, and that they can make it difficult for patients to understand how decisions are being made.

The lawsuit against UnitedHealth raises a number of specific ethical concerns. First, the plaintiffs allege that UnitedHealth's algorithm is based on inaccurate and incomplete data. This raises the concern that the algorithm may be making decisions that are not based on sound medical evidence. Second, the plaintiffs allege that UnitedHealth has failed to adequately train its employees on how to use the algorithm. This raises the concern that employees may be making decisions that are not in the best interests of patients, either because they do not understand how the algorithm works or because they are pressured to deny claims.

The lawsuit also raises the general question of whether algorithms should be used to make healthcare decisions. Some argue that algorithms can be used to make more efficient and objective decisions than humans can. Others argue that algorithms are not capable of making complex medical decisions that require an understanding of the individual patient's circumstances.

The use of algorithms in healthcare is a complex issue with no easy answers. It is important to carefully consider the potential benefits and risks of using algorithms before implementing them in healthcare settings.

The Sacklers were drug dealers who put money over morality.

Chris McGreal
The Guardian
Originally published September 17, 2019

If only we could feel Purdue Pharma’s pain.

The directors and owners of the company that did so much to create America’s opioid epidemic are professing distress and bewilderment at the rejection of what they claim are its good faith efforts to help the victims.

Even as Purdue announced plans late Sunday night to file for bankruptcy, its top officials were making unctuous claims that their concern was to combat an epidemic that has claimed more than 400,000 lives. Anyone who stood in the way was depriving suffering Americans of the help they need, they claimed.

Members of the Sackler family who own Purdue have offered to turn over the company to a trust which would funnel future earnings to treatment and other measures to deal with the tragedy. They would also sell Mundipharma, a British-based sister company, and hand over the payment. The Sacklers even said they would give up a part of the huge profits of OxyContin, which made the family multibillionaires.

Some of the state attorneys general and cities suing Purdue have accepted the deal as the best prospect for getting anything out of the company and said the bankruptcy filing was part of the arrangement.

Other attorneys general rejected the move, claiming it was an attempt by Purdue’s owners and executives to hang on to the bulk of the profits of drug dealing and buy their way out of individual accountability. Some of those states are also suing the Sacklers directly.

The info is here.

Huge price hikes by drug companies are immoral

Robert Klitzman
CNN.com
Originally posted September 18, 2018

Several pharmaceutical companies have been jacking up the prices of their drugs in unethical ways. Most recently, Nirmal Mulye, founder and president of Nostrum Pharmaceuticals, defended his decision to more than quadruple the price of nitrofurantoin, used to treat bladder infections, from about $500 to more than $2,300 a bottle. He said it was his "moral requirement to sell the product at the highest price."

Mulye argues that his only moral duty is to benefit his investors. As he said in defending Martin Shkreli, who in 2015 raised the price of an anti-parasite drug, daraprim, 5,000% from $13.50 to $750 per tablet, "When he raised the price of his drug he was within his rights because he had to reward his shareholders."

Mulye is wrong for many reasons. Drug companies deserve reasonable return on their investment in research and development, but some of these companies are abusing the system. The development of countless new drugs depends on taxpayer money and sacrifices that patients in studies make in good faith. Excessive price hikes harm many people, threaten public health and deplete huge amounts of taxpayer money that could be better used in other ways.

The US government pays more than 40% of all Americans' prescription costs, and this amount has been growing faster than inflation. In 2015, over 118 million Americans were on some form of government health insurance, including around 52 million on Medicare and 62 million on Medicaid. And these numbers have been increasing. Today, around 59 million Americans are on Medicare and 75 million on Medicaid.

The info is here.

The Tech Industry’s War on Kids

Richard Freed
Medium.com
Originally published March 12, 2018

Here is an excerpt:

Fogg speaks openly of the ability to use smartphones and other digital devices to change our ideas and actions: “We can now create machines that can change what people think and what people do, and the machines can do that autonomously.” Called “the millionaire maker,” Fogg has groomed former students who have used his methods to develop technologies that now consume kids’ lives. As he recently touted on his personal website, “My students often do groundbreaking projects, and they continue having impact in the real world after they leave Stanford… For example, Instagram has influenced the behavior of over 800 million people. The co-founder was a student of mine.”

Intriguingly, there are signs that Fogg is feeling the heat from recent scrutiny of the use of digital devices to alter behavior. His boast about Instagram, which was present on his website as late as January of 2018, has been removed. Fogg’s website also has lately undergone a substantial makeover, as he now seems to go out of his way to suggest his work has benevolent aims, commenting, “I teach good people how behavior works so they can create products & services that benefit everyday people around the world.” Likewise, the Stanford Persuasive Technology Lab website optimistically claims, “Persuasive technologies can bring about positive changes in many domains, including health, business, safety, and education. We also believe that new advances in technology can help promote world peace in 30 years.”

While Fogg emphasizes persuasive design’s sunny future, he is quite indifferent to the disturbing reality now: that hidden influence techniques are being used by the tech industry to hook and exploit users for profit. His enthusiastic vision also conveniently neglects to include how this generation of children and teens, with their highly malleable minds, is being manipulated and hurt by forces unseen.

The article is here.

Are MBAs to blame for VW and other business ethics fiascos?

By  Ethan Baron
Forbes
Originally published October 22, 2015

Here is an excerpt:

So, what’s wrong with recent business people today? In an interview, Queen points to an over-emphasis on tolerance, that makes it very difficult for many people to even say something is wrong. Students are entering business schools “almost as kind of blank slates in terms of [their] ability to think about, to argue about, the good,” Queen says. “Even if they may have a business ethics class, that’s not reinforced by the other messages they’re getting either in the school, from their peers, perhaps even from the business world as a whole.”

While Queen sees what may be the start of a shift away from this line of thinking, he believes that in B-schools, students are generally still coming away with a belief that a return on investment trumps all other values. And within business programs, that ideology makes it difficult for students to swim against the current. Taking an alternate view can lead students to feel alone and alienated.

The entire article is here.