The fatal shooting of UnitedHealthcare CEO Brian Thompson on Wednesday, Dec. 4, which the NYPD have confirmed as a pre-meditated, targeted attack, has drawn attention to the insurance provider's recent legal troubles over its coverage.
Thompson, 50, was shot dead near the Hilton Hotel in midtown Manhattan at about 6:45 a.m. Wednesday, police said. A masked suspect fled the scene to a nearby alleyway and then rode away on an E-bike toward Central Park.
Police have yet to make an arrest in the midtown Manhattan shooting, and a motive behind the killing is not yet known. However, a lawsuit against the insurance provider is gaining widespread attention in the wake of the shooting.
As reported by Reuters, the lawsuit alleges that UnitedHealthcare used artificial intelligence to deny coverage to elderly patients who are on a Medicare Advantage plan, despite allegedly being aware that the algorithm has a 90 percent error rate.
The lawsuit was filed on November 14, 2023. It names UnitedHealth Group, UnitedHealthcare and NaviHealth as the defendants. It was brought by the families of two now-deceased patients who were denied coverage by UnitedHealthcare for stays at nursing homes. The suit is ongoing, and its claims have not been proved in court.
UnitedHealthcare Accused of Taking Advantage of Patients' 'Impaired Conditions, Lack of Knowledge and Lack of Resources'
The lawsuit alleges the provider continues using the system because it knows that only about 0.2 percent of policyholders will appeal their denied claims and that the majority will "either pay out-of-pocket costs or forgo the remainder of their prescribed post-acute care."
The suit says that UnitedHealthcare banks "on the patients' impaired conditions, lack of knowledge, and lack of resources to appeal the erroneous AI-powered decisions."
It goes on: "The fraudulent scheme affords Defendants a clear financial windfall in the form of policy premiums without having to pay for promised care, while the elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary medical care, all because an AI model 'disagrees' with their real live doctors' determinations."
The suit says that an AI model was used to compare a patient's diagnosis, age, living situation and physical function to similar patients to predict the person's needs, estimated length of stay and target discharge date from care facilities.
That model, however, allegedly provided "generic recommendations" that did not "adjust for a patient's individual circumstances and conflict with basic rules on what Medicare Advantage plans must cover," according to the suit.
UnitedHealth's Response to the Lawsuit
In May, UnitedHealth Group's lawyers argued the suit should be dropped because the plaintiffs "failed to exhaust the exclusive administrative appeal process set by the Medicare Act," reported the website Stat. They said the issues raised in the lawsuit are with the federal government, not UnitedHealth or its subsidiaries.
For instance, the lawsuit alleged that patients were "rarely" in a nursing home for more than two weeks before they started to receive payment denials, despite Medicare Advantage plans allowing patients who were in the hospital for three days to get up to 100 days in a nursing home. The lawsuit also says that more than 90 percent of these denials that are appealed are ultimately reversed.
NYPD Found Shell Casings at Crime Scene with 'Deny, Defend, Depose' Written on Them
The suspect in Thompson's shooting remains at large as of Thursday afternoon, with police releasing their clearest image yet of him more than 24 hours after the shooting.
"UPDATE: Below are photos of a person of interest wanted for questioning regarding the Midtown Manhattan homicide on Dec. 4. This does not appear to be a random act of violence; all indications are that it was a [premeditated], targeted attack," New York's Police Department (NYPD) wrote in a post to X.
Authorities said Thursday that bullet casings at the crime scene were emblazoned with the words deny, defend and depose, as previously reported.
