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Class action lawsuit filed November 2023 alleging nH Predict was used to deny Medicare Advantage post-acute care claims. Senate Permanent Subcommittee on Investigations report "Refusal of Recovery" (October 17, 2024) found UnitedHealth's post-acute services denial rate increased from 8.7% to 22.7% (2019-2022); skilled nursing denial rate increased ninefold. CMS issued February 2024 guidance clarifying algorithms cannot solely dictate coverage decisions. Litigation ongoing.
Federal court (March 2026) ordered broad discovery into UnitedHealth's AI claims process. UnitedHealth disputes that nH Predict makes coverage decisions, claiming it only informs providers. Plaintiffs allege the tool effectively replaced physician judgment.
Federal court (March 2026) ordered broad discovery into UnitedHealth's AI claims process. UnitedHealth disputes that nH Predict makes coverage decisions, claiming it only informs providers. Plaintiffs allege the tool effectively replaced physician judgment.
Class action lawsuit filed November 2023 alleging nH Predict was used to deny Medicare Advantage post-acute care claims. Senate Permanent Subcommittee on Investigations report "Refusal of Recovery" (October 17, 2024) found UnitedHealth's post-acute services denial rate increased from 8.7% to 22.7% (2019-2022); skilled nursing denial rate increased ninefold. CMS issued February 2024 guidance clarifying algorithms cannot solely dictate coverage decisions. Litigation ongoing.
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