UnitedHealth used algorithms to deny care, staff say — STAT Investigation


The nation’s largest medical insurance firm pressured its medical workers to chop off funds for severely unwell sufferers in lockstep with a pc algorithm’s calculations, denying rehabilitation take care of older and disabled Individuals as earnings soared, a STAT investigation has discovered.

UnitedHealth Group has repeatedly stated its algorithm, which predicts how lengthy sufferers might want to keep in rehab, is merely a guidepost for his or her recoveries. However inside the corporate, managers delivered a a lot totally different message: that the algorithm was to be adopted exactly so fee might be lower off by the date it predicted.

Inner paperwork present {that a} UnitedHealth subsidiary referred to as NaviHealth set a goal for 2023 to maintain rehab stays of sufferers in Medicare Benefit plans inside 1% of the times projected by the algorithm. Former workers stated lacking the goal for sufferers beneath their watch meant exposing themselves to self-discipline, together with doable termination, no matter whether or not the extra days have been justified beneath Medicare protection guidelines.

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