Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
A STAT investigation found artificial intelligence is driving Medicare Advantage denials to new heights, cutting off care for seniors.
This is part 1 of an ongoing investigative series.
An algorithm, not a doctor, predicted a rapid recovery for Frances Walter, an 85-year-old Wisconsin woman with a shattered left shoulder and an allergy to pain medicine. In 16.6 days, it estimated, she would be ready to leave her nursing home.
On the 17th day, her Medicare Advantage insurer, Security Health Plan, followed the algorithm and cut off payment for her care, concluding she was ready to return to the apartment where she lived alone. Meanwhile, medical notes in June 2019 showed Walter’s pain was maxing out the scales and that she could not dress herself, go to the bathroom, or even push a walker without help.
- Part 2: Denied By AI: How UnitedHealth's acquisition of a popular Medicare Advantage algorithm sparked internal dissent over denied care
- Part 3: Denied By AI: UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients' rehab care
- Part 4: Denied By AI: UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients
Dan McQuillan has been warning about this since forever, to the point where I would've assumed that he'd be referenced if not interviewed int his article, though he wasn't. Here's a pretty short one from him. His basic argument is that AI is best understood as algorithmic Thatcherism, in which they'll silicon-wash the same austerity politics that neoliberalism has been feeding us forever.
17AI is being used as a means of diverting blame from humans onto a black box. It's not inherently bad of itself, but the current hype around it is allowing it to be used in ways it shouldn't be.
11Somehow I missed this piece, thanks for sharing — as someone whose family used to be miners, I'll never pass up an opportunity to bitch about Thatcher
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This is one of the most annoying (dangerous in this case) trends of the AI rush. It has potential for incredible value, but that only depends on the people instituting it and the structures they have in place to ensure it’s successful.
I could see a world where the algorithm could receive input on the patients condition each day and modify its recommendations on that; like a Bayesian inference model. But that requires a statistician with some careful thought to set it all up, and executives wouldn’t be able to reduce headcount by several dozen because some guy sold them a black box that solves all their problems.
15depends on the people instituting it and the structures they have in place to ensure it’s successful.
Oh I'm pretty sure THEY view it as a success. Old folks with large medical bills dying? That's a feature, not a bug.
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Luckily Repubs have staunchly defended our rights to choose which Death Panel denies our care.
6Not all algorithms are AI
4Unfortunately, AI in current media is a catch-all term that applies to anything more complicated than a switch statement. (And sometimes even that)
9At this point I wouldn't be surprised to see people calling something as basic as a bash script that adds 2 numbers AI due to lack of actual understanding of what AI is.
4I legitimately had someone pitch an idea for an AI that could've just been a 15min bash adventure lol
5Permanently Deleted
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