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IncidentHealthFinanceUSReported

Families sue UnitedHealth over nH Predict algorithm used in Medicare Advantage denials

See how this story connects

Source: STATAlso reported by Becker’s Payer Issues

The families of two deceased UnitedHealthcare Medicare Advantage members filed a proposed class action in federal court in Minnesota on 14 November 2023 against UnitedHealth Group and its naviHealth unit. The complaint says the nH Predict algorithm, which estimates how long a patient needs post-acute care, was used to cut off rehabilitation and nursing home coverage, and that about 90% of appealed denials were reversed, a figure calculated by the plaintiffs. UnitedHealth said the tool is a guide and not used for coverage decisions, and that the suit has no merit.

Why it matters

Insurers using predictive tools in coverage reviews faced a court test of whether algorithm-driven denials breach plan contracts, and the case fed later congressional scrutiny of Medicare Advantage automation.

When
14 Nov 2023
ID
WTA-N-2023-0145
Who
UnitedHealth Group, UnitedHealthcare, naviHealth, Optum
System
nH Predict
Operator
UnitedHealth; naviHealth
Type
harm: coverage denial (alleged)
Status
open; disclosed by Class action complaint · Incident ledger

Summary by wheresthe.ai, from STAT and the reporting credited above. We could not open the primary document, so it is marked Reported. Checked against the source on 9 Oct 2026.

Read the original at STAT

Source copy: download the page as saved on 18 Oct 2026 (PDF). Also held by the Internet Archive.

Next stop on this Storyline: Built on bySenate report links insurer automation to rising Medicare Advantage post-acute denials

Cite this story

WTA-N-2023-0145: “Families sue UnitedHealth over nH Predict algorithm used in Medicare Advantage denials.” wheresthe.ai, 14 Nov 2023. https://wheresthe.ai/d/us-unitedhealth-navihealth-nh-predict-lawsuit-2023-11/ (source: STAT).

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