UnitedHealth sued over nH Predict AI in Medicare denials

A class-action complaint filed November 14, 2023 in the U.S. District Court of Minnesota alleges UnitedHealth Group and its subsidiary NaviHealth use an AI tool called nH Predict to cut off post-acute rehabilitation care for elderly Medicare Advantage members, and that the tool has a 90% error rate measured by how often its denials are overturned on appeal. Ars Technica reported the filing.

The suit alleges UnitedHealth kept using the model knowing that only 0.2% of denied beneficiaries appeal.

Two named plaintiffs anchor the case. Gene Lokken, 91, fractured his leg and ankle in May 2022; his family paid approximately $150,000 to keep him in nursing care after coverage was cut, and he died in July 2023. Dale Tetzloff, 74, suffered a stroke in October 2022; he and his wife paid $70,000, and he died in October 2023.

The complaint alleges "The elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary care." Internal documents cited in the filing say managers set a goal for clinical employees to keep patient rehab stays within 1% of the days projected by the algorithm, which the complaint says was built on a database of roughly six million patient records.

NaviHealth spokesperson Aaron Albright told CBS News that nH Predict is "a guide to help inform providers about what sort of assistance and care the patient may need," and that coverage decisions are "based on CMS coverage criteria and the terms of the member's plan." The company said the lawsuit has no merit.

Two experts in our Who's Who directory shared the Ars Technica filing.

The suit was brought by Clarkson Law Firm and seeks to represent Medicare Advantage members and their families going back four years.