There is a lawsuit grinding through a federal court in Minnesota that every insurance executive in America should be reading instead of their quarterly AI roadmap. The case is Estate of Lokken v. UnitedHealth Group. It was filed in late 2023 by the families of two deceased Medicare Advantage members, and it alleges that UnitedHealthcare used an artificial-intelligence tool called nH Predict to decide how much post-acute care its members were entitled to — and that the tool was wrong roughly nine times out of ten, a figure the plaintiffs draw from how often its denials were reversed on appeal. UnitedHealth denies that the tool makes coverage decisions at all; it calls nH Predict “a guide” and says the real decisions are made by clinicians […]
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