Case research · Sources checked October 12, 2026
UnitedHealth / naviHealth "nH Predict" Medicare Advantage post-acute care class action (Lokken)
Plaintiffs, Medicare Advantage enrollees and estates of deceased enrollees, allege that the defendants used an AI model called nH Predict, developed by naviHealth, to estimate how much post-acute care (such as skilled nursing facility care) a patient should need and then used those outputs to deny or cut off coverage, allegedly overriding treating physicians' recommendations. The complaint claims employees who deviated from the model's projections faced discipline, and alleges on information and belief that a large share of denials were reversed on appeal.
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- Status
- Active
- Court
- U.S. District Court for the District of Minnesota
- Docket
- 0:23-cv-03514-JRT-SGE
- Judge
- Hon. John R. Tunheim (District Judge); Hon. Shannon G. Elkins (Magistrate Judge, pretrial/discovery)
- Started
- November 14, 2023
- Defendants
- UnitedHealth Group, Inc., UnitedHealthcare, Inc., naviHealth, Inc. and 1 more
Where it stands
As of October 12, 2026
The case is in class and merits discovery after the court's February 13, 2025 order allowed the breach of contract and implied covenant claims to proceed and dismissed the other five counts with prejudice. On March 9, 2026 the magistrate judge granted in part plaintiffs' motion to compel, ordering production about nH Predict's development and use. On September 18, 2026 the court amended the schedule: plaintiffs' class-certification expert declarations are due October 14, 2026, the class certification motion is due February 16, 2027, fact discovery closes April 26, 2027, and the case is to be trial-ready on or about February 7, 2028. Defendants filed a Second Amended Answer on September 4, 2026.[4]
The complaint
What is alleged, and what is not decided
Plaintiffs, Medicare Advantage enrollees and estates of deceased enrollees, allege that the defendants used an AI model called nH Predict, developed by naviHealth, to estimate how much post-acute care (such as skilled nursing facility care) a patient should need and then used those outputs to deny or cut off coverage, allegedly overriding treating physicians' recommendations. The complaint claims employees who deviated from the model's projections faced discipline, and alleges on information and belief that a large share of denials were reversed on appeal. Defendants deny the allegations and state that physicians, not AI, make coverage determinations. The surviving claims are breach of contract and breach of the implied covenant of good faith and fair dealing.
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 (for example, diagnoses, conditions, functional status). eCFR current as of 2026-10-08.[9]
- 02
The CMS Contract Year 2024 Medicare Advantage final rule (CMS-4201-F, 88 FR 22120) was published April 12, 2023 and effective June 5, 2023; it addresses utilization management and permits MA organizations to create publicly accessible internal coverage criteria based on current evidence.
Timeline
How the case has moved
Class action complaint filed in the District of Minnesota.[8]
First Amended Class Action Complaint filed (Doc. 34), pleading seven counts and proposing a nationwide class plus Multi-State, Benefits Denial, Oregon and California subclasses.[6]
Judge Tunheim grants in part and denies in part the motion to dismiss (Doc. 91): Counts 1 (breach of contract) and 2 (implied covenant) proceed; Counts 3-7 (unjust enrichment, insurance bad faith, Oregon negligence per se, Minnesota unfair insurance practices, California UCL) dismissed with prejudice as preempted by the Medicare Act. The court waived administrative exhaustion for irreparable harm and futility.[1]
Magistrate Judge Elkins denies defendants' motion to bifurcate discovery into a named-plaintiff-only first phase (Doc. 130).[2]
Amended Pretrial Scheduling Order (Doc. 134) sets fact discovery close of December 11, 2026 and a class certification motion deadline of September 18, 2026 (later superseded).[5]
Order on plaintiffs' motion to compel (Doc. 162): UHC ordered to produce materials on post-acute care policies, nH Predict's development and use (but not source code or underlying data), government investigations into AI use in post-acute claims, AI Review Board materials, and NOMNC decision-maker identities, within 21 days.[3]
Defendants file Second Amended Answer to the First Amended Class Action Complaint (Doc. 206), asserting 24 affirmative defenses including Medicare Act preemption and failure to exhaust.[7]
Order granting joint motion to amend scheduling order (Doc. 211): class certification motion due February 16, 2027; fact discovery closes April 26, 2027; dispositive motions September 27, 2027; trial-ready on or about February 7, 2028.[4]
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 any Detailed Explanation of Non-Coverage for the skilled nursing / post-acute stay
These are the written coverage-termination notices; the court's March 2026 discovery order specifically covers the identities of NOMNC decision-makers. They establish the date coverage ended and the stated reason.
Held by: The Medicare Advantage plan; the skilled nursing facility or post-acute provider that delivered the notice
Medicare Advantage Evidence of Coverage (EOC) and plan documents for each plan year
The surviving claims are contract claims; the court limited them to breaches of EOC terms, so the exact plan language about who makes coverage decisions matters.
Held by: The Medicare Advantage plan (member services or online account); CMS plan materials
Appeal and grievance file: fast-track appeal decisions from the Quality Improvement Organization, plan reconsideration letters, Independent Review Entity and ALJ decisions
The complaint's theory centers on denials that were later reversed; the appeal record shows what happened at each level and dates.
Held by: The Medicare Advantage plan; the QIO; the Office of Medicare Hearings and Appeals (ALJ decisions)
Skilled nursing facility / rehabilitation clinical records: physician orders, therapy progress notes, nursing notes, discharge planning notes
Documents the treating clinicians' recommended level and duration of care, which plaintiffs allege the model overrode.
Held by: The SNF, inpatient rehab facility or home health agency; the attending physician's practice
Explanation of Benefits / claims statements and itemized facility bills for care paid out of pocket after coverage ended
Shows which days were covered versus denied and what the patient or family paid privately.
Held by: The Medicare Advantage plan (EOBs); the facility's billing office (itemized bills)
Any nH Predict or naviHealth report or care-coordination correspondence provided to the patient or facility
Plaintiffs in the companion Humana case allege such reports were requested and refused; any copy establishes what projection was communicated and when.
Held by: naviHealth / the plan's post-acute care coordinator; the facility's case manager
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Questions people ask
Straight answers, with sources
Is the UnitedHealth nH Predict lawsuit real, and where is it pending?
Yes. It is a putative class action, Estate of Gene B. Lokken v. UnitedHealth Group, No. 0:23-cv-03514, in the U.S. District Court for the District of Minnesota before Judge John R. Tunheim. The court ruled on the motion to dismiss on February 13, 2025.[1]
Was the case dismissed?
Partly. The court dismissed five of seven counts with prejudice as preempted by the Medicare Act, but allowed the breach of contract and breach of the implied covenant of good faith and fair dealing claims to proceed.[1]
Has a class been certified?
No. As of the September 18, 2026 scheduling order, plaintiffs' class certification motion is due February 16, 2027, with the case to be trial-ready on or about February 7, 2028. No class has been certified and no settlement has been announced in the court record reviewed.[4]
Who do plaintiffs say was affected?
The amended complaint proposes a class of people who purchased UnitedHealth Medicare Advantage plans in the four years before filing, with a 'Benefits Denial Subclass' of those whose benefits were allegedly denied due to the use of nH Predict. These are proposed definitions in a complaint, not court findings.[6]
What does UnitedHealth say?
In court filings UnitedHealth denies the allegations, states that physicians make coverage determinations, and asserts defenses including Medicare Act preemption and failure to exhaust Medicare appeals.[7]
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 and Order Granting in Part and Denying in Part Defendants' Motion to Dismiss (Doc. 91)
U.S. District Court, D. Minn., via GovInfo (USCOURTS) · govinfo.gov · opened October 12, 2026
Counts 1-2 proceed; Counts 3-7 dismissed with prejudice as preempted; exhaustion waived.
- [2]Order denying Defendants' Motion to Amend the Pretrial Scheduling Order (bifurcation) (Doc. 130)
U.S. District Court, D. Minn., via GovInfo · govinfo.gov · opened October 12, 2026
Court refuses to split discovery into a named-plaintiff-only phase.
- [3]Order on Plaintiffs' Motion to Compel Discovery Responses and Production of Documents (Doc. 162)
U.S. District Court, D. Minn., via GovInfo · govinfo.gov · opened October 12, 2026
Grants in part discovery into nH Predict development and use, government investigations, and NOMNC decision-makers.
- [4]Order Granting Joint Motion to Amend Scheduling Order (Doc. 211)
U.S. District Court, D. Minn. (court filing mirrored by Georgetown Health Care Litigation Tracker) · litigationtracker.law.georgetown.edu · opened October 12, 2026
Sets class certification motion for Feb. 16, 2027 and trial-ready date on or about Feb. 7, 2028.
- [5]Amended Pretrial Scheduling Order (Doc. 134)
U.S. District Court, D. Minn. (mirrored by Georgetown Health Care Litigation Tracker) · litigationtracker.law.georgetown.edu · opened October 12, 2026
Earlier schedule, since superseded.
- [6]First Amended Class Action Complaint (Doc. 34)
Court filing mirrored by Georgetown Health Care Litigation Tracker · litigationtracker.law.georgetown.edu · opened October 12, 2026
Seven counts; class and subclass definitions; nH Predict allegations.
- [7]Second Amended Answer to First Amended Class Action Complaint (Doc. 206)
Court filing mirrored by Georgetown Health Care Litigation Tracker · litigationtracker.law.georgetown.edu · opened October 12, 2026
Defendants' general denial and 24 affirmative defenses.
- [8]Artificial Intelligence - Medicare Advantage (issue page)
Georgetown Law O'Neill Institute Health Care Litigation Tracker · litigationtracker.law.georgetown.edu · opened October 12, 2026
Lists filing date Nov. 14, 2023 and docket 0:23-cv-03514.
- [9]42 CFR 422.101 Requirements relating to basic benefits
eCFR (U.S. Government Publishing Office) · ecfr.gov · opened October 12, 2026
MA medical necessity determinations must be based on coverage criteria and the enrollee's medical history, among other factors.