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Class action proceeding, discovery compelled March 2026; trial date to be set
Medicare Advantage members and their families filed a class action alleging UnitedHealthcare used an AI tool called nH Predict (developed by Optum subsidiary naviHealth) to deny post-acute care claims based on population-level algorithms rather than individual clinical circumstances, overriding physicians' recommendations. The complaint alleges approximately 90% of denials were overturned on appeal. On 13 February 2025 (Case No. 0:23-cv-03514, D. Minn.), the court denied UnitedHealth's motion to dismiss, allowing breach of contract and implied good faith claims to proceed. On 9 March 2026, a federal magistrate judge ordered UnitedHealth to produce broad discovery, internal documents on nH Predict's implementation, use, and outcomes. The case is the leading US litigation on AI-driven healthcare coverage denials and is shaping expectations for the forthcoming CMS rules on Medicare Advantage AI use.
Medicare Advantage members and their families filed a class action alleging UnitedHealthcare used an AI tool called nH Predict (developed by Optum subsidiary naviHealth) to deny post-acute care claims based on population-level algorithms rather than individual clinical circumstances, overriding physicians' recommendations. The complaint alleges approximately 90% of denials were overturned on appeal. On 13 February 2025 (Case No. 0:23-cv-03514, D. Minn.), the court denied UnitedHealth's motion to dismiss, allowing breach of contract and implied good faith claims to proceed. On 9 March 2026, a federal magistrate judge ordered UnitedHealth to produce broad discovery, internal documents on nH Predict's implementation, use, and outcomes. The case is the leading US litigation on AI-driven healthcare coverage denials and is shaping expectations for the forthcoming CMS rules on Medicare Advantage AI use.
Class action proceeding, discovery compelled March 2026; trial date to be set
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