UNH · News · 20260918N

Medicare Advantage Denials

UNITEDHEALTH GROUP INC · 2026-09-18 · Importance 40 · Surprise 42

A reported class-action lawsuit alleges that UnitedHealth used the nH Predict artificial-intelligence tool to deny medically necessary post-acute care for elderly Medicare Advantage beneficiaries. The complaint alleges the tool had a 90% error rate and that UnitedHealth continued using it despite allegedly knowing about the inaccuracy. Families of two deceased patients reportedly incurred out-of-pocket costs after the tool overrode physicians’ recommendations, creating litigation and regulatory-risk exposure for UnitedHealthcare’s Medicare Advantage business.

Key facts

• A class-action lawsuit alleges UnitedHealth used an AI tool called nH Predict with a 90% error rate to deny medically necessary post-acute care to elderly Medicare Advantage patients. source
• The lawsuit alleges UnitedHealth continued to use the nH Predict tool despite knowing its inaccuracy. source
• The lawsuit says families of two deceased patients detailed how they paid significant out-of-pocket costs after the AI tool overrode physicians' care recommendations. source