AI, Medical Debt & The Murder of Brian Thompson
Someone shot dead is rare but not unusual: About 46 people are murdered every day in the United States by someone with a gun, according to Gun Violence Statistics. In a country with more than 337 million people, it’s unlikely it’ll happen to you.
But if an upper crust 50-year-old white male is gunned down on New York City’s Sixth Avenue, in the heart of swanky midtown Manhattan, it’s a very different story. The usual gun victim in the United States is black, a Native American or an Alaska Native, statistics say.
Brian Thompson was, by some accounts, a mild-mannered individual, approachable, likeable and a solid colleague, too. His murder is a tragic, criminal event that can never be justified.
On the video recording his death, he was stalked, shot and killed around 6:45 a.m. on Wednesday, Dec. 4th.
Two days ago, 26-year-old Luigi Mangione was picked up at a McDonald’s in Altoona, Pa., after a customer spotted what they thought was someone looking very similar to the man who killed Thompson. He’s been charged with murder.
Given Thompson’s title, CEO of UnitedHealthcare, the health insurance arm of UnitedHealth Group, the courtroom hosting this trial could very well take on a very different tone other than a murder trial. Besides arguing over the obvious – did the police pick up the right man? – other issues could arise.
What’s At Stake
“Delay,” “deny” and “depose” were written on the casings of the bullets that are thought to have been used in Thompson’s murder, police say. Add to what’s also been reported, and there’s every chance this could turn into a show trial about health insurance, maybe even the medical industry.
As with another high-profile trial in New York City, involving a former Marine, defense attorneys will need to work hard at gaining a jury’s sympathy if they hope for any leniency should their client be convicted – and this approach might work.
Recent numbers on the amount of medical debt Americans carry are staggering.
Two months ago, the Consumer Financial Protection Bureau reported that 100 million Americans are carrying about $220 billion in medical debt, and it may not be their fault.
“Medical billing is often riddled with errors, including inflated or duplicative charges, fees for services the patient never received, or charges already paid,” said CFPB Director Rohit Chopra in the news release reporting the $220 billion in medical debt. “The CFPB is taking action to ensure that Americans are not unfairly chased by debt collectors over unsubstantiated or invalid medical bills.”
Every year, about 530,000 bankruptcies in the United States are due to medical costs, according to the National Library of Medicine.
Looking Under The Hood
A U.S. Senate report, published about eight weeks ago, puts UnitedHealth Group in a bad light. Looking at the claims of senior citizens in the Medicare Advantage program, the U.S. Senate Permanent Subcommittee on Investigations found that in 2019, UnitedHealthcare “issued an initial denial to 8.7% of the post-acute care prior authorization requests it received; by 2022, it denied 22.7% of all such requests.”
The report also says UnitedHealthcare tested “Machine-Assisted Prior Authorization (MAP)” to determine the care that would be covered or not covered. Was this an AI program?
Emails seeking clarification and comment from UnitedHealth Group about this report weren’t immediately returned. Telephone calls seeking a response from U.S. Sen. Richard Blumenthal’s office (D-Conn.), who chairs the Senate Subcommittee, weren’t returned either.
The report said, “The minutes for the Utilization Management Program Committee (UMPC) (an internal UnitedHealth Group committee) described MAP generally and noted that while it was ‘never a valid source to justify approval or denial of a case,” it was a ‘tool’ that ‘points the clinician to significant sources of primary evidence’ used in evaluating a prior authorization request. When Committee members asked ‘whether the software creates the potential risk of bias, ‘they were told that the doctor or nurse reviewing the case was responsible or verifying that ‘the primary evidence is acceptable.’”
The UMPC committee “while discussing the auto authorization model, expressed concern about the costs of ‘increasing manual review rates’ in the UnitedHealthcare division responsible for Medicare Advantage plans,” the report says.
“Taken together,” the report says, “these documents suggest that (1) UnitedHealthcare was evaluating the use of automated prior authorization procedures; (2) the company knew from testing that at least one of these automation technologies resulted in an increase in the share of those requests being denied; (3) this model was associated with less time spent evaluating prior authorization requests; and (4) the company was interested in reducing the money it spent on human reviewers of cases for the group covering Medicare Advantage plans.”
The Senate Subcommittee’s conclusion might be the most damning part:
“Medicare Advantage has grown rapidly in recent years and is, as of 2023, larger than Traditional Medicare. Despite the enormous growth in enrollment, some two dozen health systems have announced over the past year that they will stop accepting Medicare Advantage beneficiaries, with hospitals and providers overwhelmingly citing frustration with prior authorization. Prior authorization was one of the tools given to insurers participating in the program to help them prevent harmful or unnecessary medical services, but as HHS (U.S. Department of Health & Human Services) OIG (Office of the Inspector General) and others have warned, the structure of Medicare Advantage can incentivize companies to use the process to deny care to which patients are entitled.”
Another report, from The Commonwealth Fund, published in August, details a recent survey of Americans and their issues with being denied coverage from their health insurer.
Does exasperation and indignation over health insurance justify Brian Thompson’s murder? Of course not!
But with hundreds of millions of Americans feeling the weight of medical debt, and a sizable amount unable to pay it, Luigi Mangione might very well receive a sympathetic hearing from a compassionate jury and, quite possibly, a lesser sentence if convicted.
