UnitedHealth kept AI care-denial tool despite 90% appeal reversal rate, lawsuit says
aakashgupta · x · 2026-09-22
A lawsuit reveals UnitedHealth's care-denial algorithm nH Predict loses 9 out of 10 appeals, yet the company kept running it—knowing only 2 in 1,000 patients would ever file one. Run the math: with a 0.2% appeal rate and 90% reversal rate, a denial that's wrong nine times out of ten still sticks over 99.8% of the time.
nH Predict came from naviHealth, acquired in 2020. Case managers input a patient's age, living situation, and physical function; the model compares them against millions of past cases to project a discharge date. Former employees told STAT it fails to account for mid-stay complications like pneumonia after a stroke. After deployment, UnitedHealth's skilled-nursing care denial rate in 2022 ran 9x higher than in 2019.
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