how automated healthcare fails, how you'd know, and what to do at each tier — every claim sourced, reviewed continuously
A class action alleges UnitedHealth used naviHealth's nH Predict model to cut off post-acute care; a Senate investigation found UnitedHealthcare's post-acute denial rate nearly tripled while it automated prior authorization.
TierThe automation stayed up and kept producing output that was wrong or went unchecked; there was no outage to fall back from. How tiers are assigned.
In November 2023 families of two deceased Medicare Advantage members filed a proposed class action in Minnesota alleging that UnitedHealth used nH Predict to override physicians and end post-acute coverage, that the model had a 90% error rate, and that the insurer relied on only about 0.2% of members appealing. naviHealth said the tool is a guide, not used to make coverage determinations. These are allegations. In February 2025 Judge John Tunheim dismissed five of seven counts but let contract and good-faith claims proceed, calling the appeals process futile. Separately, the Senate Permanent Subcommittee on Investigations reported in October 2024 that UnitedHealthcare's post-acute prior-authorization denial rate rose from 8.7% in 2019 to 22.7% in 2022 while its overall denial rate stayed about 7.5%, during a period of automation initiatives. One internal model test noted an increase in adverse determinations. CMS stated in February 2024 that a length-of-stay prediction alone cannot be the basis to terminate post-acute care.[1,2,3,4]
Complaint alleges patients were discharged from care facilities or paid out of pocket; not adjudicated.
All incidents · Models & agents · Human handoff
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