UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care

STAT News recently reported on UnitedHealth’s use of a restrictive algorithm, developed by subsidiary NaviHealth, to limit Medicare patients’ rehabilitation care, potentially violating Medicare rules. Initially presented as a guide, this algorithm was internally enforced to cut payments precisely as predicted, pressuring medical staff and risking their employment. The algorithm’s rigid application by UnitedHealth and other major health plans, including Humana, has led to substantial cost savings but raised legal concerns and a notable increase in expedited appeals against service termination. Concurrently, a lawsuit was filed against UnitedHealth for these practices, and U.S. Representatives urged CMS to oversee the use of AI in Medicare Advantage plan decisions.