A class action regarding UnitedHealthcare’s alleged use of artificial intelligence to deny care for Medicare Advantage members will continue playing out in court, but with fewer claims.
In a court filing Thursday, a federal judge said two of seven claims brought against UnitedHealth Group by health plan members and their families — who alleged the company used AI to deny coverage for medically necessary post-acute care — can move forward.
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UnitedHealth Group has been battling the lawsuit, filed in the U.S. District Court for the District of Minnesota, since November 2023. Plaintiffs have alleged the company's health insurance unit UnitedHealthcare used an AI tool called nH Predict to make coverage decisions, sometimes overriding physician judgment.
The plaintiffs also claimed UnitedHealthcare breached its insurance contract, which stated the health insurer would pay for covered and medically necessary health services and that UnitedHealthcare’s clinical services staff and physicians make coverage decisions.
UnitedHealth Group acquired the tool’s software developer NaviHealth in 2020. UnitedHealthcare and NaviHealth are also defendants.
UnitedHealth Group did not respond to a request for comment regarding Thursday’s court order. The company has previously stated that the AI tool is not used to make coverage decisions, but rather to assist providers. Last May, the insurer filed a motion to dismiss the case, arguing that the plaintiffs had not completed the full appeals process to challenge the denials and that federal Medicare law preempts state laws the plaintiffs claimed it violated.
The court, in part, agreed. “The only claims that survive, then, are the claims for breach of contract and for breach of the implied covenant of good faith and fair dealing because the Court will only need to evaluate compliance with the insurance agreements,” U.S. District Judge John Tunheim wrote in the filing Thursday.
Insurance coverage denials have long frustrated patients and providers. The murder of UnitedHealthcare CEO Brian Thompson in December has ignited a new wave of public discontent against burdensome health insurance practices, including prior authorization, care denials and rising costs.
Plaintiffs for this case said their lack of coverage forced some to pay thousands of dollars for care, caused some health conditions to worsen, and led to some members' deaths. Cigna and Humana are also facing lawsuits over their alleged use of AI to deny care.
UnitedHealthcare denied 9.1% of prior authorization requests in 2023, which was above the industry average of 6.4%, according to a report by the healthcare policy research organization KFF published last month. Industry-wide, Medicare Advantage members appealed only 11.7% of denied pre-authorization requests in 2023, but 81.7% of those appeals were partially or fully overturned, according to the report.
