When an algorithm decides if you qualify for medical treatment, from American public media,

this is Marketplace Tech, I'm Megan McCarty Carino. Reno.

Artificial intelligence has become a big part of medicine in reading images,

formulating treatment plans, and developing new drugs.

But a recent investigation by Stat News found some insurers are over relying on an algorithm to make

coverage decisions for seniors on Medicare Advantage. Those are plans approved by Medicare

but offered by private insurers.

Casey Ross co reported the story and says the algorithm predicts how long a patient needs care.

Based on this projected length of stay by an algorithm, patients in the facility were then

getting coverage denied in concert with that projected length of stay regardless of their actual condition based on the assessment of their in-person providers.

And so this algorithm, which was purchased by United Health Group in 2021, started getting applied to patients and nursing

homes all over the country and the providers started to become aware of it, but the patients had no idea and no ability to sort of question the algorithm or the decisions that were being made.

And in your story, you write about the case of Francis Walter can you tell me more about

that? Sure Francis Walter was in her 80s when she suffered a fall and she broke her shoulder. She had her shoulder surgically repaired and then she was transferred to a skilled nursing facility to recover. The algorithm that United Health Group owns under its

Nava Health subsidiary was then run on Francis Walter and the algorithm projected that she would take about 16.6 days to recover.

But Francis Walter was a complicated patient.

She had an allergy to pain medicines and she took longer to recover but the algorithm had suggested that date and that's the date that payment for her care was cut off and her family wasn't prepared for that she lived

alone and so she had to leave the nursing facility and what happens at that point

for these families and what happened for the Walter family was they had to decide do we pay out of pocket to keep her there or what do we do and so Francis Walter is then made to enroll in Medicaid and she has to she has to pay down her life savings to pay for extra care.

She enrolls in Medicaid to continue to get the coverage.

And then, you know, she files an appeal. Medicaid to continue to get the coverage.

And then she files an appeal.

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