The fatal shooting of UnitedHealthcare CEO Brian Thompson on Wednesday, which New York City police have described as "brazen" and "targeted," occurred after the insurance provider has faced legal scrutiny over its coverage.
Police have yet to make an arrest in the midtown Manhattan shooting, and a motive remains unclear. The shooting drew an array of reactions, with many critics not entirely sympathetic as they pointed out that the company has denied coverage to some patients. Others, however, slammed those reactions as insensitive, saying that a killing isn't justified and that acts of violence should be denounced.
One criticism of UnitedHealthcare that has garnered attention following the shooting involves a lawsuit alleging the company uses artificial intelligence (AI) to deny coverage to some elderly patients who are on a Medicare Advantage plan, despite allegedly being aware that the algorithm has a 90 percent error rate.
The lawsuit was filed on November 14, 2023. It names UnitedHealth Group, UnitedHealthcare and NaviHealth as the defendants. It was brought by the families of two now-deceased patients who were denied coverage by UnitedHealthcare for stays at nursing homes. The suit is ongoing, and its claims have not been proved in court.
Newsweek reached out via email to UnitedHealthcare for comment.
The lawsuit alleges the provider continues using the system because it knows that only about 0.2 percent of policyholders will appeal their denied claims and that the majority will "either pay out-of-pocket costs or forgo the remainder of their prescribed post-acute care."
The suit says that UnitedHealthcare banks "on the patients' impaired conditions, lack of knowledge, and lack of resources to appeal the erroneous AI-powered decisions."
It goes on: "The fraudulent scheme affords Defendants a clear financial windfall in the form of policy premiums without having to pay for promised care, while the elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary medical care, all because an AI model 'disagrees' with their real live doctors' determinations."
The suit says that an AI model was used to compare a patient's diagnosis, age, living situation and physical function to similar patients to predict the person's needs, estimated length of stay and target discharge date from care facilities.
That model, however, allegedly provided "generic recommendations" that did not "adjust for a patient's individual circumstances and conflict with basic rules on what Medicare Advantage plans must cover," according to the suit.
In May, UnitedHealth Group's lawyers argued the suit should be dropped because the plaintiffs "failed to exhaust the exclusive administrative appeal process set by the Medicare Act," reported the website Stat. They said the issues raised in the lawsuit are with the federal government, not UnitedHealth or its subsidiaries.
For instance, the lawsuit alleged that patients were "rarely" in a nursing home for more than two weeks before they started to receive payment denials, despite Medicare Advantage plans allowing patients who were in the hospital for three days to get up to 100 days in a nursing home.
The lawsuit also says that more than 90 percent of these denials that are appealed are ultimately reversed.
Some in the health care industry have been raising concerns about the use of AI in insurance. A Newsweek report found that concerns are particularly prevalent for patients on Medicare Advantage plans, which are provided by private insurance companies that have contracts with the federal government.
The AI lawsuit is among the examples of scrutiny UnitedHealthcare is facing following the fatal shooting of its CEO. But as some critics cited the lawsuit after the shooting, or even joked about it, others viewed these reactions as crass.
"Just a reminder that Brian Thompson, the CEO of UnitedHealth who was just shot and killed in NY, was a human being with a family. So many of the comments on his murder are despicable," wrote Julie Nelson, an anchor at Minnesota news station KARE, in a post to X (formerly Twitter).
The suspect in Thompson's shooting was still at large Thursday afternoon, with police releasing their clearest image yet of him more than 24 hours after the shooting.
"UPDATE: Below are photos of a person of interest wanted for questioning regarding the Midtown Manhattan homicide on Dec. 4. This does not appear to be a random act of violence; all indications are that it was a [premeditated], targeted attack," New York's Police Department (NYPD) wrote in a post to X.
Thompson, 50, was shot dead near the Hilton Hotel in midtown Manhattan at about 6:45 a.m. Wednesday, police said. A masked suspect fled the scene to a nearby alleyway and then rode away on an E-bike toward Central Park.
Thompson was taken to Mount Sinai Hospital, where he was pronounced dead. He was expected to speak at an investor presentation at the Hilton later in the day for UnitedHealthcare, the largest private health insurer in the U.S. He had served as the company's CEO since 2021.
Authorities said Thursday that a bullet found at the shooting scene was emblazoned with the words deny, defend and depose, ABC News reported.
NYPD Commissioner Jessica Tisch told reporters at a Wednesday press conference that the suspect was "lying in wait" for several minutes before the shooting.
"Many people passed the suspect, but he appeared to wait for his intended target. I want to be clear: At this time, every indication is that this was a premeditated, preplanned, targeted attack," she said.
In a statement, UnitedHealth Group said the company is "deeply saddened and shocked" by the shooting.
"Brian was a highly respected colleague and friend to all who worked with him. We are working closely with the New York Police Department and ask for your patience and understanding during this difficult time. Our hearts go out to Brian's family and all who were close to him," the statement reads.