In November 2023, the families of two deceased patients filed a proposed class action lawsuit in the US against UnitedHealth Group, one of the country’s largest health insurers, and its subsidiary naviHealth. They allege the companies used an AI tool called nH Predict to wrongfully deny elderly patients in Medicare Advantage plans coverage for care after a hospital stay, such as physical therapy or skilled nursing care. According to the complaint, Gene Lokken, 91, was covered for only 19 days of care after a fall, despite his doctors recommending more, and his family paid around $150,000 until his death.
The tool uses information such as age, living situation and physical function to compare patients with millions of past cases and estimate how long they should need care. The lawsuit alleges that the company applied these estimates even when they went against doctors’ recommendations, and that staff were pressured to keep patients’ stays close to the tool’s predictions. Over 90% of the denials that were appealed were reversed, but only about 0.2% of patients ever appealed. UnitedHealth denies the claims, saying the tool is used as a guide and not to make coverage decisions.
In February 2025, a federal court in Minnesota allowed part of the case to proceed, and in March 2026 a judge ordered UnitedHealth to hand over a wide range of documents on how the tool was implemented and used. The case is still ongoing and raises important questions about transparency and accountability when algorithms influence decisions about patients’ care.
Learn more here: https://www.statnews.com/2023/11/14/unitedhealth-class-action-lawsuit-algorithm-medicare-advantage/
Read the latest update here: https://www.yahoo.com/news/us/articles/lawsuit-says-unitedhealth-used-ai-173017952.html
References:
Ross, C., & Herman, B. (2023, November 14). UnitedHealth faces class action lawsuit over algorithmic care denials in Medicare Advantage plans. STAT.
Becker’s Payer Issues. (2026, March 11). Judge orders UnitedHealth to hand over documents in AI coverage denial case.
Barrientos, A. (2026, September 18). Lawsuit says UnitedHealth used AI with a 90% error rate to deny care. Yahoo News.