Insurers Accused of Malpractice

A class-action lawsuit alleges that **UnitedHealth Group** used an algorithm to deny necessary rehabilitation care, despite claimants arguing the system had a high rate of error. A federal judge has allowed the case to proceed.

In **November 2023**, a collective lawsuit was filed against **UnitedHealth Group** and its subsidiary **NaviHealth** in a federal court in **Minnesota**. The main accusation is that the insurer employed an algorithm, known as **nH Predict**, to deny rehabilitation treatments for patients with serious conditions. According to the plaintiffs, the company was aware that this system presented a considerable error rate.

## Algorithm Under Scrutiny

The lawsuit details that **UnitedHealthcare** allegedly used **nH Predict** to override doctors' medical judgment and, thus, deny coverage to patients, particularly the elderly. The '90% error' figure arises from appeals: when patients appealed these denials, either internally or before federal administrative judges, more than **90%** of the rejections were overturned. The plaintiffs interpret this high reversal rate as proof of the algorithm's failure.

## Insurer's Defense

The lawsuit also points out that the company was aware that only **0.2%** of insured individuals typically appealed denials. Despite this, they allegedly continued using the system, despite knowing its frequent ineffectiveness when reviewed. **UnitedHealth Group**, for its part, has denied these accusations. A company spokesperson stated that the **nH Predict** tool is used as a guide and not for making final coverage decisions, assuring that these are based on criteria established by the **Centers for Medicare and Medicaid Services (CMS)**.

## Case Advances

In **2025**, a federal judge in **Minnesota** dismissed five of the seven counts presented in the lawsuit. However, the case has been cleared to continue under claims of breach of contract and bad faith. It is important to note that this involves allegations within a lawsuit, not a final judgment proving the **90%** rate as judicial fact. The **90%** metric is an estimation by the plaintiffs based on the denial reversal rate, and does not originate from an independent audit of the algorithm.