~90%
of denials allegedly overturned on appeal
What the research found
A class action alleges UnitedHealth used an AI tool, nH Predict, to deny post-acute care to elderly Medicare Advantage members with a roughly 90% error rate — nine in ten denials reversed on appeal — while overriding physicians' judgement. Plaintiffs argue it stayed in use because only about 0.2% of patients appeal. A court has ordered the algorithm disclosed.
Why it matters for providers
A live example of AI in the administrative layer denying medically necessary care at scale, with accountability unclear. Claims are unproven allegations in ongoing litigation.
Original source
CBS News (reporting on ongoing litigation)
A commercial survey or unproven litigation — indicative only; treat with caution.