UnitedHealth Sued Over Alleged Use of Flawed AI Tool to Deny Patient Care
A proposed class-action lawsuit has been filed against UnitedHealth Group and its subsidiary NaviHealth in the US District Court for the District of Minnesota. The case, Estate of Gene B. Lokken et al. v. UnitedHealth Group Inc., et al., alleges that the companies used an AI tool called nH Predict to deny post-acute care owed to elderly Medicare Advantage patients.
The AI model, which has a 90% error rate, was fed patient data and projected discharge dates based on age, living situation, and physical function. However, former employees stated in investigative reporting that the algorithm does not fully account for comorbidities or complications that emerge mid-stay.
The plaintiffs argue that UnitedHealth was aware of the reversal rate but continued using the tool because most patients would not challenge denials, leaving the vast majority of allegedly wrongful coverage cuts uncorrected. The families of two elderly patients put specific dollar figures to what they claim the algorithm cost them: $150,000 and $70,000.
A federal judge has ordered UnitedHealth to open its records on the algorithm, which may reshape how insurers nationwide are permitted to use AI in utilization management.