Clarkson has filed class action lawsuits against all three insurers, alleging that they used AI tools to systematically deny or cut short medically necessary care for Medicare Advantage patients. The lawsuits allege that these companies deployed algorithms they knew to be highly inaccurate rather than relying on genuine physician review.

nH Predict is an AI tool developed by naviHealth, a company acquired by UnitedHealth Group. The tool generates predictions about how much post-acute care — skilled nursing, inpatient rehabilitation — a patient is expected to need. UnitedHealth and Humana both used it to determine coverage cutoffs. Plaintiffs allege the tool routinely contradicted treating physicians and carried an error rate of approximately 80% when denial decisions were challenged at the Administrative Law Judge level.

Primarily Medicare Advantage enrollees — seniors aged 65 and older who chose private insurance plans in lieu of traditional Medicare. These individuals paid premiums for coverage that, in many cases, their insurers refused to honor when they needed post-acute care following hospitalization. The lawsuits also cover their families and estates in cases where patients have since died.

You may qualify to be part of a class action if you were a Medicare Advantage enrollee with UnitedHealth, Humana, or Cigna and had post-acute care coverage denied or cut short in ways that contradicted your treating physician's recommendations. Contact us to discuss your situation.

The active Clarkson litigation focuses on Medicare Advantage, which is the private insurance alternative to traditional Medicare. However, similar algorithmic tools may be used across commercial insurance products, and related concerns apply more broadly. The federal government is also piloting AI-based review within traditional Medicare.

These lawsuits are establishing legal precedent for how courts treat AI-driven healthcare decisions. They are compelling companies to produce internal records that reveal how these tools were designed, deployed, and evaluated. The outcomes will shape what insurers are and are not permitted to do with AI in the claims process, affecting every patient in the country who relies on health insurance coverage.