Humana's Hidden Horrors: Profits Over Patients

A class-action lawsuit alleges that Humana used a flawed AI algorithm, nH Predict, to deny post-acute care coverage for elderly patients under Medicare Advantage plans.

The AI model allegedly overrode doctors’ recommendations, prematurely cutting off care for patients in skilled nursing facilities. Plaintiffs claim the algorithm was inaccurate and designed to maximize profits by denying necessary care. The lawsuit seeks damages and an injunction to stop the use of the AI tool.

Humana's reliance on flawed AI technology undermines patient care and prioritizes profits over health.

Community Health Network sued Humana for failing to reimburse $7.4 million in outpatient drug costs under the 340B program, which serves low-income patients.

The lawsuit accuses Humana of breach of contract and unjust enrichment, alleging that Humana withheld payments for drugs provided between 2018 and 2022. This case highlights systemic reimbursement issues within Medicare Advantage plans.

Humana's failure to reimburse under the 340B program jeopardizes access to essential medications for low-income patients.

Humana sued the Centers for Medicare & Medicaid Services (CMS) over its downgraded star ratings for Medicare Advantage plans, which could significantly impact Humana’s revenue and enrollment.

Humana claims that CMS unfairly penalized it based on outdated or incorrect data. The lawsuit is part of a broader industry pushback against CMS star rating methodologies. Lower ratings could result in reduced bonuses and competitive disadvantages for Humana.

Humana's lawsuit challenges the integrity of CMS's rating system, threatening its financial stability and market position.

Plaintiffs allege that Humana denied rehabilitation care to seniors, forcing families to pay out-of-pocket or forego necessary treatment.

An elderly plaintiff was denied continued rehabilitation after a leg fracture, despite her doctor’s recommendation. Families claim they incurred tens of thousands of dollars in costs due to improper denials. The lawsuit asserts these denials violated good faith practices required by insurance contracts.

Humana's unjust denials of rehabilitation care place undue financial and health burdens on seniors and their families.

Whistleblowers allege that Humana submitted inflated risk adjustment claims to Medicare Advantage, leading to overpayments from CMS.

Similar cases against other insurers have resulted in DOJ investigations into fraud within Medicare Advantage programs. Whistleblowers claim Humana pressured providers to add unsupported diagnoses to patient records to increase payments. These practices are part of broader scrutiny into risk adjustment fraud across the industry.

Humana's fraudulent risk adjustment claims undermine Medicare's integrity and defraud taxpayers.

Plaintiffs allege that Humana systematically delayed or denied claims processing, violating consumer protection laws and insurance regulations.

The lawsuit accuses Humana of bad faith practices, including ignoring clinical determinations by doctors. Plaintiffs argue these practices caused financial hardship and worsened health outcomes for policyholders. The case seeks damages and injunctive relief to reform claims handling processes.

Humana's unfair claims settlement practices inflict financial and health burdens on policyholders, undermining trust in insurance services.

Lawsuits allege that Humana’s use of AI tools like nH Predict may violate patient privacy laws by improperly sharing sensitive health data with third parties during algorithmic decision-making processes.

Critics argue that relying on external data sources for AI models risks breaches of HIPAA compliance. Regulators are investigating whether insurers like Humana adequately protect patient information during automated claims processing. These concerns overlap with broader congressional inquiries into AI use in healthcare.

Humana's AI-driven data practices jeopardize patient privacy and violate federal regulations.

Hospitals and clinics have repeatedly accused Humana of failing to reimburse them adequately under federal programs like Medicaid or Medicare Advantage.

Community Health’s $7.4 million lawsuit is an example of broader reimbursement disputes involving safety-net hospitals. Providers argue that payment delays or denials disproportionately harm low-income patients reliant on federal programs. These cases highlight challenges with insurer compliance under complex federal reimbursement frameworks.

Humana's persistent failure to reimburse undermines the financial stability of safety-net providers and compromises patient care.

Lawmakers are investigating whether insurers like Humana improperly deny care under Medicare Advantage, particularly for seniors requiring post-hospitalization treatments.

Congressional hearings have focused on high denial rates for medically necessary care compared to traditional Medicare. Advocacy groups argue that insurers prioritize profits over patient health by limiting access to follow-up care. These investigations could lead to stricter regulations on coverage decisions in Medicare Advantage.

Congressional scrutiny threatens to impose stricter regulations on Humana's coverage denial practices, potentially reshaping Medicare Advantage policies.

Advocacy groups have accused Humana of disproportionately denying care or imposing stricter coverage limits on vulnerable populations, including low-income seniors and minorities.

Plaintiffs argue that systemic biases in AI algorithms exacerbate disparities in access to care. Previous lawsuits have highlighted barriers faced by non-English-speaking policyholders when appealing denied claims. These allegations align with broader concerns about equity in healthcare delivery under private insurance plans.

Humana's discriminatory practices deepen healthcare disparities, marginalizing already vulnerable populations.