UnitedHealth nH Predict Lawsuit: The AI Care-Denial Claims

What the Lawsuit Alleges

Filed in late 2023 by the families of two deceased Medicare Advantage beneficiaries, the class action alleges UnitedHealth used an AI tool called nH Predict — from its naviHealth subsidiary — to decide how much post-acute care, such as skilled-nursing or in-home rehabilitation, elderly patients should get, and to cut off coverage prematurely. The suit alleges the tool effectively overrode physicians and that around 90% of its denials were reversed on appeal — suggesting the denials were frequently wrong.

The claim is that the company used an unreliable algorithm to deny medically necessary care in bad faith.

The Status

The case is proceeding, and a federal magistrate judge ordered UnitedHealth to turn over a wide range of documents about how nH Predict was built and used — a significant discovery win for the plaintiffs. UnitedHealth’s Optum unit disputes the allegations, characterizing nH Predict as a care-support tool rather than a claims-adjudication tool, and says physicians make the medical-necessity calls.

The case sits alongside the Cigna algorithm suit in a broader reckoning over automated insurance decisions.

What Patients Should Know

Medicare Advantage members can appeal a coverage cutoff for skilled-nursing or rehab care, and expedited appeals exist when care is ending. Given how often such denials are overturned, appealing is often worthwhile. Keep the denial notice, the care plan and the provider’s documentation of medical necessity.