Case research · Sources checked October 12, 2026
Humana "nH Predict" Medicare Advantage post-acute care class action (Barrows)
Plaintiffs, Humana Medicare Advantage enrollees and an estate, allege that Humana used the nH Predict AI model to make post-acute care coverage determinations by comparing a patient's diagnoses, age, living situation and function to similar patients, allegedly supplanting treating physicians' recommendations and cutting coverage off prematurely. The complaint also claims Humana and its contractor naviHealth requested updated records and issued new denials after successful appeals, forcing patients to restart the process.
Every line on this page is checked against the court docket and the regulators involved. We do not decide whether you are part of this case or match you with a lawyer. What we do is help you get the medical records that matter, from any provider.
- Status
- Active
- Court
- U.S. District Court for the Western District of Kentucky, Louisville Division
- Docket
- 3:23-cv-00654-RGJ-CHL
- Judge
- Hon. Rebecca Grady Jennings (District Judge)
- Started
- December 12, 2023
- Defendants
- Humana Inc.
Where it stands
As of October 12, 2026
On August 15, 2025 the court granted in part and denied in part Humana's motion to dismiss: breach of contract, implied covenant, unjust enrichment and common-law fraud claims proceed; four state-law insurance claims were dismissed with prejudice. The case is in class-certification discovery under a July 17, 2026 amended scheduling order (ECF No. 135); as of the August 24, 2026 joint status report, Humana had made its 18th document production and the parties were scheduling depositions of Humana employees. The court accepted Humana's Amended Answer by agreed order in late August 2026. The tracker's docket listing also shows a Second Amended Complaint filed September 29, 2026, which was not opened.[5]
The complaint
What is alleged, and what is not decided
Plaintiffs, Humana Medicare Advantage enrollees and an estate, allege that Humana used the nH Predict AI model to make post-acute care coverage determinations by comparing a patient's diagnoses, age, living situation and function to similar patients, allegedly supplanting treating physicians' recommendations and cutting coverage off prematurely. The complaint also claims Humana and its contractor naviHealth requested updated records and issued new denials after successful appeals, forcing patients to restart the process. Humana denies using nH Predict to make adverse coverage determinations and says denials are individualized decisions by physician medical directors applying Medicare coverage criteria.
On the record
What the regulators and the court have said
- 01
CMS regulations at 42 CFR 422.101(c)(1)(i) require Medicare Advantage organizations to make medical necessity determinations based on, among other things, the plan's coverage and benefit criteria and the enrollee's medical history (diagnoses, conditions, functional status). eCFR current as of 2026-10-08.[8]
- 02
The CMS Contract Year 2024 Medicare Advantage final rule (CMS-4201-F) was published April 12, 2023, effective June 5, 2023, and addresses MA utilization management and internal coverage criteria.
Timeline
How the case has moved
Class action complaint filed (ECF No. 1).[3]
First Amended Complaint filed (ECF No. 37) asserting eight counts; Humana moves to dismiss (ECF No. 40).[3]
Court denies the motion to dismiss the original complaint as moot, grants plaintiffs' request for oral argument on Medicare Act preemption, and sets a hearing for April 16, 2025 (DE 69).[2]
Memorandum Opinion and Order (DE 82): motion to dismiss granted in part and denied in part. Counts I (breach of contract), II (implied covenant), III (unjust enrichment) and VIII (common law fraud) proceed; Counts IV-VII (North Carolina unfair claims and unfair competition, insurance bad faith, Minnesota unfair insurance practices) dismissed with prejudice as preempted. Exhaustion excused where required.[1]
Rule 26(f) report (ECF No. 88) proposes class certification motion by June 25, 2026 and class-related discovery close of August 20, 2026 (later amended).[3]
Joint status report (ECF No. 130): Humana has made fourteen document productions; parties await ruling on June 8, 2026 joint motion to amend the schedule (ECF No. 127).[4]
Joint status report: parties on track under the July 17, 2026 amended scheduling order (ECF No. 135); Humana's 15th-18th productions made; Rule 30(b)(1) deposition notices served for three Humana employees.[5]
Agreed Order accepting Humana's Amended Answer and Affirmative Defenses, which denies using nH Predict for adverse coverage determinations and asserts 29 defenses.[6]
If this involves you
The records that matter, and who has them.
Whatever you decide to do next, you will be asked for these. They are yours by law, and most providers have up to 30 days to send them once they have your signed request.
Notice of Medicare Non-Coverage (NOMNC) and Detailed Explanation of Non-Coverage for each post-acute stay
Establishes the date and stated basis on which Humana ended coverage for the skilled nursing or rehab stay.
Held by: Humana (member services / appeals department); the skilled nursing facility that delivered the notice
Humana Medicare Advantage Evidence of Coverage for the relevant plan year
The court treated the EOC as part of the contract and allowed the contract and fraud claims to proceed on the basis of its terms.
Held by: Humana (plan documents are also typically available in the member online account)
Complete appeal file: fast-track QIO appeal decisions, Humana reconsideration letters, Independent Review Entity and ALJ decisions, and any requests for updated records
Plaintiffs allege repeated denials after successful appeals; the appeal record shows each decision and date.
Held by: Humana; the Quality Improvement Organization; the Office of Medicare Hearings and Appeals
Facility clinical records: physician orders, therapy evaluations and progress notes, nursing notes, discharge summaries
Documents the treating clinicians' assessment of needed care against which the alleged algorithmic projection is compared.
Held by: The skilled nursing facility, inpatient rehabilitation facility or home health agency; the attending physician
Any written request to Humana or naviHealth for the nH Predict report, and the response
Plaintiffs allege such requests were denied; the correspondence shows what was asked for and what was provided.
Held by: Humana / naviHealth care coordination; the patient or family's own records
Explanation of Benefits statements and itemized bills for days paid privately after coverage ended
Shows which services were covered, denied, and paid out of pocket.
Held by: Humana (EOBs); facility billing office (itemized statements)
We send the request, follow up with the provider, and deliver the records to you. We don't take case details here and we never share your records with a law firm unless you tell us to.
Questions people ask
Straight answers, with sources
Is the Humana nH Predict lawsuit real?
Yes. Estate of Joanne Barrows v. Humana Inc., No. 3:23-cv-00654, is pending in the U.S. District Court for the Western District of Kentucky before Judge Rebecca Grady Jennings; the court ruled on Humana's motion to dismiss on August 15, 2025.[1]
Which claims survived?
Breach of contract, breach of the implied covenant of good faith and fair dealing, unjust enrichment and common-law fraud proceed. Four state-law insurance claims were dismissed with prejudice as preempted by the Medicare Act.[1]
Has a class been certified or a settlement reached?
No. As of the August 24, 2026 joint status report the parties were in class-certification discovery under a July 17, 2026 scheduling order, and no certification ruling or settlement appears in the filings reviewed.[5]
What does Humana say?
Humana denies using nH Predict to make adverse coverage determinations, says post-acute care denials are individualized decisions by physician medical directors applying CMS criteria, and admits only that it contracted with naviHealth for utilization management of certain post-acute care in certain states and periods.[6]
How does this case relate to the UnitedHealth case?
The Humana court followed the District of Minnesota's reasoning in Lokken v. UnitedHealth on Medicare Act preemption, holding that contract-based claims resolvable by reading the Evidence of Coverage are not preempted.[1]
Sources
Where every fact on this page comes from
Primary sources only: court orders, the Judicial Panel on Multidistrict Litigation, federal regulators and state attorneys general. Each entry shows the day we opened it. This is reference material, not legal or medical advice.
- [1]Memorandum Opinion & Order on Motion to Dismiss (DE 82)
U.S. District Court, W.D. Ky., via GovInfo (USCOURTS) · govinfo.gov · opened October 12, 2026
Counts I, II, III, VIII proceed; Counts IV-VII dismissed with prejudice.
- [2]Order setting preemption hearing (DE 69)
Court filing mirrored by Georgetown Health Care Litigation Tracker · litigationtracker.law.georgetown.edu · opened October 12, 2026
Names Judge Rebecca Grady Jennings; sets April 16, 2025 argument.
- [3]Rule 26(f) Report (ECF No. 88)
Court filing mirrored by Georgetown Health Care Litigation Tracker · litigationtracker.law.georgetown.edu · opened October 12, 2026
Confirms complaint filed Dec. 12, 2023 and amended complaint Apr. 22, 2024; proposed schedule.
- [4]Joint Status Report (ECF No. 130)
Court filing mirrored by Georgetown Health Care Litigation Tracker · litigationtracker.law.georgetown.edu · opened October 12, 2026
Discovery progress; schedule amendment pending.
- [5]Joint Status Report, Aug. 24, 2026
Court filing mirrored by Georgetown Health Care Litigation Tracker · litigationtracker.law.georgetown.edu · opened October 12, 2026
Parties on track under July 17, 2026 order (ECF No. 135); depositions being scheduled.
- [6]Defendant's Amended Answer and Affirmative Defenses / Agreed Order
Court filings mirrored by Georgetown Health Care Litigation Tracker · litigationtracker.law.georgetown.edu · opened October 12, 2026
Humana denies using nH Predict for adverse determinations.
- [7]Barrows et al. v. Humana Inc. (case page)
Georgetown Law O'Neill Institute Health Care Litigation Tracker · litigationtracker.law.georgetown.edu · opened October 12, 2026
Docket listing of 44 filings through Oct. 8, 2026, incl. Second Amended Complaint Sept. 29, 2026.
- [8]42 CFR 422.101
eCFR · ecfr.gov · opened October 12, 2026
MA medical necessity determination requirements.