The assassination of UnitedHealthcare’s CEO happened on December 4, 2024. Brian Thompson, was shot dead in a precisely planned attack in Manhattan, in front of the Hilton Hotel while preparing for an investor meeting. Police determined that the attacker fired at close range, and the suspect’s backpack containing counterfeit money and clothing was found in Central Park. Luigi Mangione was detained in the case.
The health insurance system in the US – why is it so expensive?
The U.S. health system relies on private insurance, which is often provided by employers. The lack of a universal public system means that the uninsured must pay the full cost of treatment themselves. Health care bills are high because:
- Lack of price regulation: The cost of medical services and drugs is negotiated between hospitals and insurance companies, leading to significant price differences.
- Complexity of the system: Extensive bureaucracy and the need for billing between multiple entities increase administrative costs.
- Advanced technology: Hospitals in the U.S. often use high-tech equipment and treatment methods, which raises the price of services.
- Private company profits: Both insurance companies and hospitals operate for profit, which affects fees.
As a result, even people with insurance may face difficulties paying their bills if their claims for coverage are denied, as happened with UnitedHealthcare’s AI system.
Artificial intelligence in health insurance – condemning people to problems?
Under Thompson, the company implemented the AI nH Predict algorithm, which significantly reduced access to benefits after hospitalization, rejecting up to 90% of claims. Previously, this work was done by a group of designated employees. System ignored doctors’ opinions, went against Medicare Advantage rules, and rejected decisions were often later overturned on appeal. Implementation of AI sparked widespread criticism, accusations of ethics violations and lawsuits. The company was accused of seeking to cut costs at the expense of patients, which could escalate customer dissatisfaction.
AI nH Predict algorithm – How does it more or less work?
The AI nH Predict algorithm, used by UnitedHealthcare, is an artificial intelligence tool developed to analyze claims for health care coverage. The system was designed to improve the decision-making process for granting or denying benefits. Its operation was based on:
- Analysis of patient data: The algorithm used historical data such as medical records, treatment costs and results of previous decisions.
- Risk assessment: The system automatically assessed whether a case was eligible for coverage, based on predicted treatment outcomes and cost estimates for the insurer.
- Real-time decisions: Requests were processed quickly to reduce patient waiting times, but in practice led to massive rejections.
- Automatic rejections: The algorithm was particularly strict on cases where there was any ambiguity or lack of clear medical data, resulting in rejections of up to 90% of applications.
Problems and controversies of the AI nH Predict algorithm
- Ignoring doctors’ opinions: the system often overruled decisions made by attending physicians, relying solely on statistics and predictive models.
- High error rate: It was estimated that up to 90% of rejections by nH Predict were later canceled on appeal, indicating significant shortcomings in the algorithm.
- Ethical objections: The implementation of nH Predict was criticized as a tool aimed at maximizing profits at the expense of patient health. Patients were forced to self-fund treatment or forgo care.
Deny – Defend – Depose
The assassination of the CEO of UnitedHealthcare contributed to the atomization, the slogans “deny”, “defend”, “depose” (reject, defend, refute), as they were engraved on bullets found at the scene. They are probably taken from the title of the book “Delay, deny, defend” by Jay M. Feinman.
Possible interpretations of the words are:
- “Deny” (reject): Refers to decisions made by the AI nH Predict algorithm, which indiscriminately rejected patients’ requests for medical coverage, often in controversial ways.
- “Defend” (defend): May symbolize the struggle of patients and doctors for their rights against decisions made by the company. UnitedHealthcare has repeatedly defended its policies, arguing that the system works according to the rules and optimizes costs.
- “Depose” (overturn): This term may suggest a desire to “depose” the company’s leaders who are responsible for implementing controversial practices, such as the use of AI algorithms.
Summary
The assassination of UnitedHealthcare CEO Brian Thompson has cast a shadow over the company’s controversial practices. The introduction of the AI nH Predict algorithm was supposed to streamline the decision-making process, but in fact led to massive rejections of health care claims, prompting a wave of criticism and patient frustration. In the face of such tension, the question arises:
If UnitedHealthcare had not implemented the AI algorithm and decisions had been made traditionally, could Brian Thompson have avoided his tragic fate?
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