UnitedHealthcare's nH Predict AI model cut off elderly patients' care with a claimed 90% appeal-reversal rate

UnitedHealthcare / UnitedHealth Group (via subsidiary naviHealth)·nH Predict AI modelUnresolved

UnitedHealthcare used its nH Predict AI model, built on a database of six million prior patients, to predict how much post-acute care a Medicare Advantage patient "should" need and to pinpoint when to cut off payment, allegedly overriding treating physicians' recommendations.

Blast radius

A federal class action alleges named plaintiffs faced tens of thousands of dollars in out-of-pocket care costs and worsened health after coverage was cut early; the suit says patients who appealed denials won more than 90% of the time, and claims span patients in over a dozen states.

Root cause

An automated predictive model was used to drive high-stakes coverage cutoff decisions with, plaintiffs allege, insufficient individualized clinical review.

How it was caught

A STAT News investigation and a subsequent wrongful-denial class-action lawsuit against UnitedHealth Group.

What changed

A federal judge dismissed five of seven counts in February 2025 but allowed breach-of-contract claims to proceed; litigation is ongoing and UnitedHealth disputes the claims, saying the tool is only a planning guide, not a coverage-determination system.

Take-awayIf a predictive model informs a decision that can end someone's care or benefits, enforce meaningful human clinical review before the model's output becomes the action.