Class Action Lawsuits filed against Cigna, UHC, Humana for improper use of AI Algorithms

Unless you’ve been living under a rock, you’ve heard about the shady AI algorithms used by third-party insurance companies like Cigna, United Healthcare (UHC), and Humana to systematically deny health insurance claims submitted by healthcare providers for reimbursement.  For years, third-party payers have been profiting from these sketchy cost containment strategies with little scrutiny and oversight.

When ProPublica broke the PxDx story back in March 2023, a whirlwind of lawsuits followed.  PxDx was Cigna’s AI-generated algorithm that was used for over a decade to deny health insurance claims and bypass the requirement of a Medical Doctor reviewing and making the final determination (as required by law).  To put things into perspective – in just two months, Cigna physicians denied over 300,000 medical claims for payment.  This, in effect, means that Cigna physicians spent 1.2 seconds (on average) “reviewing” and denying each claim.  According to a former Cigna physician, “we literally click and submit – it takes all of 10 seconds to do 50 denials at a time.  One doctor rejected 60,000 claims in one month.” 

Since the ProPublica story broke, there have been multiple class action lawsuits filed against Cigna, UHC, and Humana for their use of AI tools in health insurance claims denials and health insurance coverage decisions.  The lawsuits allege these payers “wrongfully delegated their obligation to evaluate and investigate claims to the AI system and fraudulently misled its customers into believing their health plan would individually assess their claims”.  More developments to follow as these lawsuits progress through litigation!

Read more about the AI algorithms used by third-party payers here:  https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims

https://healthpayerintelligence.com/news/lawsuit-alleges-humana-used-ai-to-deny-medically-necessary-claims

https://jamanetwork.com/journals/jama-health-forum/fullarticle/2816204

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