A federal magistrate judge in Minnesota has ordered UnitedHealth Group to produce a wide range of documents in an ongoing lawsuit accusing the insurer of using an AI algorithm to wrongfully deny Medicare Advantage members post-acute care.
The March 9 order largely sided with plaintiffs in their motion to compel discovery, granting or partially granting requests across six of seven categories.
The case, originally filed in 2023 by the families of two deceased Medicare Advantage members, centers on UnitedHealthcare’s use of nH Predict, a tool developed by Optum subsidiary naviHealth. In 2024, the company rebranded naviHealth to Home & Community Care. The plaintiffs allege the tool overrode physicians’ decisions and led to premature denials of medically necessary skilled nursing facility care, which Optum has disputed.
“Claims that naviHealth is used to make adverse benefit or coverage decisions are false,” an Optum spokesperson told Becker’s. “Medical necessity determinations are made by qualified physicians following CMS guidance — not AI.”
The company said nH Predict is a care-support tool that factors in a patient’s cognition, mobility, and ability to perform daily activities, and is shared with providers and caregivers to help guide recovery planning. Optum also noted that naviHealth is not generative AI.
Under the court’s order, UnitedHealth must produce documents dating back to January 2017 on its policies and procedures for post-acute care claims, all documents analyzing or discussing nH Predict, records related to its acquisition of naviHealth in relation to post-acute care cost savings, and documents concerning government investigations into the company’s use of AI in claims adjudication. The company must also produce performance evaluation and compensation records for post-acute care coordinators and medical directors, documents related to its internal AI review board and the identities of its members, and the names and contact information for medical directors and care coordinators involved in coverage denials for 300 members of the proposed nationwide class action.
The court rejected UnitedHealth’s efforts to limit several of those requests, including its argument that documents predating July 2019, when nH Predict was deployed, were not relevant. The judge found that pre-2019 records could serve as circumstantial evidence, noting that a 2024 Senate investigation found that UnitedHealth’s denial rate for post-acute care claims more than doubled after it began using naviHealth and nH Predict.
The court denied some requests, including demands for nH Predict’s source code and underlying medical guidelines, broad financial data on UnitedHealth’s business entities, all employee disciplinary records, and documents related to internal investigations not connected to nH Predict or post-acute care.
UnitedHealth has 21 days to produce the required documents.
