The Lying Machine

A lawsuit in Minnesota federal court alleges UnitedHealthcare used an AI tool called nH Predict to deny post-acute care coverage to Medicare Advantage members, with roughly 90% of those denials later reversed on appeal. The case, Estate of Lokken v. UnitedHealth Group, was filed in late 2023 by families of two deceased members. UnitedHealth denies the tool makes coverage decisions, calling it a guide for clinicians.

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 … The post