UnitedHealth Sued Over Coverage Denials
The insurance giant uses an artificial intelligence tool to allegedly deny post-acute care coverage to Medicare Advantage members, a newly filed lawsuit says. Separately, the Justice Department is dropping an antitrust case against a UnitedHealth Group affiliate over hiring agreements.
Modern Healthcare:
UnitedHealth Sued Over AI, Medicare Advantage Denials
UnitedHealth Group faces a potential class-action lawsuit over its use of an artificial intelligence tool to allegedly deny post-acute care coverage to Medicare Advantage members. The plaintiffs, family members of two deceased UnitedHealthcare Medicare Advantage policyholders, filed the lawsuit Tuesday in the U.S. District Court for the District of Minnesota and aim to represent a national class of similarly affected enrollees. The lawsuit alleges that the health insurance company breached its contracts with members, which resulted in unjust enrichment under federal law. (Tepper, 11/14)
Reuters:
US Drops Antitrust Case Over Healthcare Hiring Agreements
The U.S. Justice Department has asked a judge to dismiss the government's prosecution of a UnitedHealth Group affiliate accused of unlawfully restricting employee mobility, marking a new setback in the government's push to apply criminal antitrust laws to labor markets. U.S. prosecutors in a filing in federal court in Dallas asked U.S. District Judge Sam Lindsay to dismiss charges against Surgical Care Affiliates LLC and a related entity, SCAI Holdings LLC. (Scarcella, 11/14)
Modern Healthcare:
How Amazon Echo, Alexa Improve Patient Satisfaction
Health systems are deploying Amazon’s voice-enabled virtual assistant Alexa in an attempt to improve the patient experience. Los Angeles-based Cedars-Sinai, Phoenix Children’s Hospital and Clearwater, Florida-based BayCare Health System are among the health systems using Alexa-enabled devices in patient rooms to assist in a range of functions, from setting room temperature to translating clinician encounters for non-English speakers. (Turner, 11/14)
In news about health care personnel —
CBS News:
Howard Brown Health Workers Back On Strike For 2 Days At Chicago Clinics
The Illinois Nurses Association said they have been in contract negotiations for over a year, seeking better wages, a smaller workload, affordable insurance, and protections from layoffs. The strike is scheduled to last Tuesday and Wednesday, with a rally scheduled for Wednesday night at the Howard Brown Health clinic at 3501 N. Halsted St. Howard Brown Health is the largest LGBTQ+ healthcare clinic system in the Midwest. (Feurer, 11/14)
Modern Healthcare:
Kaiser Medicare Advantage Ratings Dipped Due To Staff Shortages
Kaiser Permanente is diversifying in response to declines in Medicare Advantage star ratings and threats from large insurers and retailers. The Oakland, California-based integrated system suffered a setback in its Medicare Advantage business when it experienced one of the industry's biggest declines in quality ratings this year, with four of its seven plans losing out on bonus payments. (Tepper, 11/14)
Stat:
Hospitals Look To New Technology To Keep Health Care Workers Safe
One day in early 2020, just weeks before Philadelphia entered lockdown, Thomas Jefferson University’s public safety lead Joseph Byham abandoned a brisk walk to respond to an urgent incident. A clinician at one of Jefferson’s Center City hospitals had pressed a badge-worn button summoning security immediately: a traumatic brain injury patient was attempting to flee, and they feared it would escalate into violence. By the time Byham arrived, the patient had escaped to the stairwell and was surrounded by six hospital staff, each of whom had been automatically notified that a nearby colleague was in distress. Once security arrived, the patient was returned to their hospital bed, and staff resumed rounds uninjured. (Ravindranath, 11/15)
Stat:
Life Scientists Are Leaving Academia For Biotech, Imperiling Research
Step inside Natasha Sheybani’s office at the University of Virginia, where she runs a bioengineering lab, and you’ll find a kaleidoscopic sea of sticky notes. She uses purple for ideas sparked by meetings, orange for future grant proposals. But she’s most excited about the yellow stickies, which Sheybani saves for moonshots: projects that are high-risk and high-reward. (Wosen, 11/15)
