What happened

According to a lawsuit brought by the Clarkson Law Firm, when patients appeal denials meted out by nH Predict to federal administrative law judges, about 90 percent were reversed.

The use of nH Predict coincides with a significant increase in claim denials, with  UnitedHealthcare's denials for post-acute care reportedly increasing by 227 percent in 2022 alone. 

Lawyers for UnitedHealth argued that the lawsuit should be dropped because plaintiffs failed to complete Medicare’s appeals process and that their grievances are with the federal government and not UnitedHealth.

Why it happened

Insurers are accused of pressuring case managers to adhere to the algorithm's recommendations, even against the advice of clinicians and families. 

The use of such algorithms is estimated to automate 50-75 percent of human labour involved in claims processing.