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A federal lawsuit alleges that UnitedHealthcare used naviHealth’s nH Predict algorithm to help cut short or end Medicare Advantage patients’ post-acute care—and that the companies knew the tool had a 90% error rate. That number is an allegation in the complaint, not a court finding or an independently verified measure of how often the system wrongly denied care. The case remains unresolved as of August 18, 2026.
What was the lawsuit about?
The estates of Gene B. Lokken and Dale Henry Tetzloff filed a putative class action on November 14, 2023, in the U.S. District Court for the District of Minnesota. The complaint names UnitedHealth Group, UnitedHealthcare, naviHealth and unnamed defendants. It alleges that nH Predict was used in decisions affecting elderly Medicare Advantage beneficiaries’ coverage for post-acute care, including skilled nursing and rehabilitation-related services. The case is 23-cv-3514. Read the complaint.
The plaintiffs contend that coverage was reduced or terminated despite treating clinicians’ assessments that patients needed more care. The allegations concern the two named beneficiaries and a proposed class; they have not all been proven in court. The complaint describes harm to the patients and their families, but a patient’s later decline or death alone does not establish that a coverage decision caused it.
How does nH Predict fit into a coverage decision?
nH Predict is described in public reporting as a predictive or decision-support tool associated with naviHealth. It generated estimates about a patient’s expected post-acute-care needs and length of stay. That estimate is not itself a formal coverage determination: a prediction, a utilization-management recommendation, an insurer’s decision and an appeal outcome are distinct steps.
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Fix the driver behind crashes, sound loss and screen glitchesFind Drivers →Repair Windows errors before they cause bigger problemsFix Now →Scan for outdated or missing drivers - takes under a minuteDriver Scan →The plaintiffs’ account is that a treating physician or facility could recommend continued care, the model could estimate a shorter care trajectory, and the insurer’s review process could then end or reduce coverage in a way that conflicted with the clinical team’s view. Patients facing a cutoff may have to appeal, pay privately, leave the facility or move to another care setting. This describes the alleged mechanism; the public record does not establish that every UnitedHealthcare case followed this sequence.
UnitedHealthcare and naviHealth have said nH Predict was intended to support discharge planning and was not used to make coverage determinations. They have also said its length-of-stay estimates were not coverage rules, and that decisions were based on CMS criteria and members’ plan terms. The companies called the lawsuit meritless. CBS News reported on the companies’ response; KFF Health News also described the dispute. Whether a tool formally designated as advisory nevertheless influenced coverage decisions is a factual issue in the litigation.
What does “90% error rate” mean?
The complaint alleges that the defendants knew nH Predict had a 90% error rate. That claim should not be restated as “the system wrongly denied 90% of claims.” The complaint’s headline-level allegation does not establish a reproducible denominator or methodology explaining what counted as an error.
For example, an error could refer to a mismatch between a predicted and actual length of stay, a recommendation later overridden, a coverage denial reversed on appeal, or another internal performance measure. Those are not interchangeable. The available public sources do not establish the 90% figure as an independently audited or peer-reviewed accuracy rate, nor do they show that it measures the share of claims denied incorrectly. The complaint is the source of the allegation.
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What broader evidence has emerged?
Reporting on patient experiences
KFF Health News reported cases in which nH Predict’s estimated length of stay appeared to align with the point at which nursing-home coverage was cut off, even though treating clinicians believed more care was needed. The outlet also reported that naviHealth said the tool supported discharge planning rather than making coverage decisions. Its reporting described similar utilization-management concerns at other insurers, so the issue is not limited to this lawsuit or company.
Senate investigation of post-acute-care authorizations
An October 2024 Senate Permanent Subcommittee on Investigations report examined UnitedHealthcare, Humana and CVS, which together covered nearly 60% of Medicare Advantage enrollees at the time of the inquiry. The committee reviewed more than 280,000 pages of documents and concluded that the insurers used prior authorization to target costly post-acute-care stays. The Senate report said UnitedHealthcare’s post-acute-care prior-authorization denials rose significantly amid automation initiatives, that skilled-nursing-facility denials accelerated after naviHealth began managing post-acute care, and that the company sought to use machine learning to identify cases likely to be appealed.
The report and KFF’s reporting provide context for scrutiny of automated utilization management and the incentives around post-acute care. They do not prove every allegation about Lokken or Tetzloff, establish that every denial was unlawful or medically incorrect, or independently validate the complaint’s 90% figure.
Where does the case stand?
The lawsuit has moved beyond its initial filing but has not produced a final judgment. The court dismissed some claims, including state-law claims it found preempted, while allowing breach-of-contract and breach-of-the-implied-covenant claims to proceed.
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On March 9, 2026, the court granted in part and denied in part the plaintiffs’ motion to compel discovery. It treated evidence about UnitedHealthcare’s practices before and after nH Predict’s introduction as potentially relevant, including training, incentives, performance evaluations, denials and policy changes. The order concerns discovery; it is not a finding that the complaint’s allegations are true. Read the March 9, 2026 order.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.What rules apply to Medicare Advantage decisions involving algorithms?
This case concerns Medicare Advantage, where private insurers administer Medicare-covered benefits under contracts with the federal government. It is not a blanket lawsuit about every UnitedHealthcare insurance product or every kind of claim. Medicare Advantage rules and 2024 federal guidance clarify that plans cannot make medical-necessity decisions using software or an algorithm that fails to account for an individual’s circumstances, and medical-necessity denials must receive review by a health-care professional. These requirements do not categorically bar algorithms from assisting with administrative work or clinical review. The dispute includes whether the actual process complied with applicable rules and the beneficiaries’ plan terms. KFF’s policy brief explains the regulatory landscape.
Appeal routes and protections can differ for traditional Medicare, Medicaid managed care, employer coverage and Affordable Care Act marketplace plans. State protections may add restrictions on automated review, although ERISA preemption can complicate how state rules apply to self-funded employer plans.
What to do if a Medicare Advantage plan cuts off post-acute care
These steps are general information, not legal advice. Appeal deadlines and procedures depend on the notice and circumstances; ask the plan or a qualified advocate about the applicable deadline.
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1Clear out junk files and repair common Windows errors2Scan for outdated or missing drivers - takes under a minute3Repair Windows errors before they cause bigger problems- Get the written denial or termination notice. Ask for the specific reason, effective date and appeal instructions.
- Ask the treating physician or facility to document the need for continued care. Request a clear explanation of the services needed, the expected benefit and the risks of stopping or transferring care.
- Ask about an expedited appeal if delay could seriously jeopardize health or the ability to regain function. Follow the instructions on the notice and contact the plan’s Medicare Advantage appeals department promptly.
- Request the records and criteria used in the decision. Keep the request and response with the denial paperwork.
- Keep a dated record of communications. Save notices and copies of calls, faxes and portal messages, including names or reference numbers when available.
- Seek navigation help. Medicare and a State Health Insurance Assistance Program (SHIP) can help people understand the process. A Medicare-advocacy organization or elder-law attorney may be useful when a patient faces discharge against the treating team’s recommendation.
CMS’s Medicare Managed Care Appeals & Grievances guidance was updated effective July 6, 2026.
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