{"data":{"event":{"id":"6a3b1cec-cb30-421d-a7e2-0de227a7dcb9","slug":"unitedhealth-nh-predict-coverage-denials","title":"UnitedHealth’s nH Predict algorithm is accused of driving post-acute care denials","short_summary":"A November 2023 STAT investigation and the Lokken class action allege that naviHealth’s nH Predict model was used to cut Medicare Advantage rehab stays; UnitedHealth says the tool is only a guide.","full_description":"Internal targets allegedly pushed stays within 1 percent of the model’s prediction. Plaintiffs claim high overturn rates on appeal and patient harm including death. In 2025 a Minnesota court let contract and good-faith claims proceed while dismissing others. Whether nH Predict is “AI” in the frontier-model sense and whether it caused denials remain disputed.","ledger_type":"harm","primary_domain_id":"c09546b6-10f8-48df-8347-0c1979416464","event_status":"disputed","event_date":"2023-11-14T00:00:00.000Z","discovery_date":"2023-11-14T00:00:00.000Z","first_published_date":"2023-11-14T00:00:00.000Z","last_reviewed_date":"2023-11-14T00:00:00.000Z","geographic_scope":"United States Medicare Advantage members","affected_population":"UnitedHealthcare Medicare Advantage patients in post-acute care (class alleged)","base_impact_tier":4,"base_score":"30.00","attribution_multiplier":"0.4000","evidence_multiplier":"0.5000","realization_multiplier":"0.6000","durability_multiplier":"0.5000","current_event_score":"1.260000","confidence_level":"medium","score_explanation":"If proven, algorithmic denial of rehab for many elderly patients is historic-scale health harm (tier 4). Attribution and causation are contested (0.40). STAT plus a surviving lawsuit (0.50). Realization is alleged denials with some documented cases. Status is disputed.","methodology_version_id":"d7881163-fb23-4e71-8625-bac1a8662c0f","original_methodology_version_id":"d7881163-fb23-4e71-8625-bac1a8662c0f","published_at":"2023-11-14T00:00:00.000Z","created_at":"2026-09-13T20:47:20.075Z","updated_at":"2026-09-13T20:47:20.075Z","flags":[],"domain_name":"Medicine & Health","domain_slug":"medicine-health","methodology_version":"0.1"},"contributions":[{"id":"179810ae-8c77-451c-9469-736d9138ea10","event_id":"6a3b1cec-cb30-421d-a7e2-0de227a7dcb9","model_id":"dc877e1a-79bc-4338-8649-fbe56729a8bd","role_description":"Predicted post-acute length of stay used, plaintiffs say, to time coverage cutoffs.","attribution_multiplier":"0.4000","credit_share":"0.7000","contribution_score":"1.260000","attribution_rationale":"Plaintiffs place the model at the center of denials; the company denies it makes coverage decisions.","attribution_confidence":"medium","first_used_date":"2023-01-01T00:00:00.000Z","model_version_if_known":null,"review_status":"approved","created_at":"2026-09-13T20:47:20.075Z","model_slug":"nh-predict","model_name":"nH Predict","identity_class":"named_release","is_internal":false,"family_name":"nH Predict","family_slug":"unitedhealth-nh-predict","organization_name":"UnitedHealth Group","organization_slug":"unitedhealth"}],"sources":[{"id":"8c4ac3de-2e33-4768-9570-f01acca7ed04","event_id":"6a3b1cec-cb30-421d-a7e2-0de227a7dcb9","url":"https://www.govinfo.gov/content/pkg/USCOURTS-mnd-0_23-cv-03514/pdf/USCOURTS-mnd-0_23-cv-03514-1.pdf","canonical_url":"https://www.govinfo.gov/content/pkg/USCOURTS-mnd-0_23-cv-03514/pdf/USCOURTS-mnd-0_23-cv-03514-1.pdf","source_type":"regulatory_record","publisher":"U.S. District Court District of Minnesota","author":null,"publication_date":"2025-02-13T00:00:00.000Z","retrieved_at":"2026-09-13T20:47:20.075Z","title":"Lokken v. UnitedHealth Group, motion-to-dismiss order","excerpt":null,"content_hash":null,"source_reliability_class":"medium","is_primary_source":true,"is_independent":true,"is_peer_reviewed":false,"archived_url":null,"created_at":"2026-09-13T20:47:20.075Z"},{"id":"a5957918-7dfb-4da0-bbcf-65e3fe7cc5f1","event_id":"6a3b1cec-cb30-421d-a7e2-0de227a7dcb9","url":"https://www.statnews.com/2023/11/14/unitedhealth-algorithm-medicare-advantage-investigation/","canonical_url":"https://www.statnews.com/2023/11/14/unitedhealth-algorithm-medicare-advantage-investigation/","source_type":"journalism","publisher":"STAT","author":null,"publication_date":"2023-11-14T00:00:00.000Z","retrieved_at":"2026-09-13T20:47:20.075Z","title":"UnitedHealth used algorithms to deny care, staff say","excerpt":null,"content_hash":null,"source_reliability_class":"medium","is_primary_source":false,"is_independent":true,"is_peer_reviewed":false,"archived_url":null,"created_at":"2026-09-13T20:47:20.075Z"}],"claims":[{"id":"3f81ec9b-8375-4b42-b445-d1fed164e29a","event_id":"6a3b1cec-cb30-421d-a7e2-0de227a7dcb9","claim_text":"UnitedHealth employees were pressured to align rehab stays with nH Predict outputs, according to STAT and the complaint.","claim_type":"outcome","claim_status":"supported","confidence_score":null,"created_at":"2026-09-13T20:47:20.075Z","updated_at":"2026-09-13T20:47:20.075Z"},{"id":"7052aa8f-5030-4ea4-bed2-0ea4b6649c4c","event_id":"6a3b1cec-cb30-421d-a7e2-0de227a7dcb9","claim_text":"nH Predict, rather than clinicians, made legally binding coverage decisions.","claim_type":"attribution","claim_status":"disputed","confidence_score":null,"created_at":"2026-09-13T20:47:20.075Z","updated_at":"2026-09-13T20:47:20.075Z"}],"revisions":[{"id":"c9964174-9f40-43eb-9fb6-0814763375bb","event_id":"6a3b1cec-cb30-421d-a7e2-0de227a7dcb9","model_id":null,"previous_score":"0.000000","new_score":"1.260000","previous_factors":{},"new_factors":{"evidence":0.5,"base_score":30,"durability":0.5,"attribution":0.4,"realization":0.6},"change_reason":"Initial adjudicated seed score under methodology 0.1.","trigger_type":"seed","trigger_source_ids":null,"reviewer_id":null,"review_status":"published","created_at":"2026-09-13T20:47:20.075Z"}],"secondary":[{"name":"Computer Science","slug":"computer-science"}]},"methodology_version":"0.1"}