A letter from the executive editor: STAT’s investigation into a UnitedHealth algorithm

I want to bring your attention to a vitally important investigation STAT has published today. For more than a year, our reporters have documented how the use of artificial intelligence is driving denial of claims or delaying treatment for seriously ill patients.

This latest story goes even deeper, establishing how the denial of claims was by design. We reveal that the nation’s largest health insurance company pursued a strategy to pressure its medical staff to cut off payments for seriously ill patients in lockstep with a computer algorithm’s calculations, denying rehabilitation care for older and disabled Americans as profits soared.

Three former case managers said the personal stories behind the algorithmic denials were haunting: In one instance, an older woman found in the laundry room by her grandson after a stroke, her right side paralyzed, was allotted 20 days of rehab by the algorithm, when the average for severely impaired stroke patients is almost double that.

To read this investigation, I hope you’ll consider a subscription to STAT+. We are offering a special 25% off discount for readers of this letter. Just use the promo code STAT25 when signing up. Beyond this discount, we also offer academic and nonprofit rates, as well as group subscriptions for teams of two to 10, and licenses. You can get more information here.

This story about UnitedHealth Group is a cautionary sign as businesses and our culture are increasingly infatuated with data-driven decision-making. Reporters Casey Ross and Bob Herman write that in health care, less sophisticated technology is already threatening basic human safety. Algorithms and AI tools are being empowered to help make consequential decisions about the treatment of patients who have a limited understanding of these products.

A subscription will give you access to all of STAT’s reporting on UnitedHealth and Medicare Advantage (see below), as well as unlimited access to our exclusives, investigations, and in-depth daily coverage of biotech, health tech, health insurance companies, health policy, and public health (including a flood of authoritative stories over the last few days about drugs for obesity as well as cardiovascular treatments).

Earlier STAT investigations and other coverage:

• Denied by AI: How Medicare Advantage plans use algorithms to cut off care; and how UnitedHealth’s acquisition of a popular Medicare Advantage algorithm sparked internal dissent over denied care.
• In addition to insurance, UnitedHealth is now one of the nation’s largest health care providers.
• White House moves to crack down on Medicare Advantage insurers who use algorithms to turn down coverage.
• UnitedHealth and Optum rebrand tech-driven care management company, drop NaviHealth name.

Thank you for reading STAT. As always, please reach out to me with feedback. I’m at [email protected].

Best wishes,

Richard L. Berke
Co-founder & Executive Editor