Minneapolis, Minnesota — A federal judge has ordered UnitedHealth Group to hand over a sweeping set of internal records tied to an artificial intelligence tool accused of prematurely cutting off nursing home care for elderly Medicare Advantage members — and the documents could expose years of decision-making the company has long kept private.
The March 9 ruling from a federal magistrate in Minnesota largely sided with plaintiffs in their motion to compel discovery, granting or partially granting requests across six of seven document categories. The order gives attorneys for the plaintiffs direct access to internal records that UnitedHealth had previously fought hard to shield.
What the AI Was Supposed to Do — and What It’s Accused of Doing
At the center of the case is nH Predict, a tool developed by naviHealth, a care management company that Optum — a UnitedHealth subsidiary — acquired in 2020. The company later rebranded naviHealth as Home & Community Care in 2024. Plaintiffs allege the tool routinely overrode physicians’ clinical judgment, generating denials of medically necessary skilled nursing facility care for elderly patients on Medicare Advantage plans.
One of the most striking allegations: nH Predict carried a 90% error rate, meaning nine out of every ten denied claims were ultimately reversed on appeal. Plaintiffs argue UnitedHealth continued using the tool anyway because only about 0.2% of policyholders ever appeal a denied claim — making the math work in the insurer’s favor, even as patients lost access to care.
UnitedHealth disputes that characterization. An Optum spokesperson told industry reports that nH Predict doesn’t make coverage determinations and that medical necessity decisions are made by qualified physicians following CMS guidance — not AI. The company describes the tool as a care-support resource shared with providers and caregivers to help guide recovery planning.
What UnitedHealth Must Now Produce
Under the court’s order, UnitedHealth must produce internal policies on post-acute care claims adjudication dating back to January 2017 — well before nH Predict’s 2019 deployment. The court rejected UnitedHealth’s argument that pre-2019 records were irrelevant, noting that a 2024 Senate investigation found the company’s denial rate for post-acute care more than doubled after it began using naviHealth and nH Predict.
The order also requires UnitedHealth to turn over all records analyzing nH Predict’s design and function, documents tying the naviHealth acquisition to post-acute care cost savings, records related to any government investigations into its AI use, and personnel compensation records for post-acute care coordinators and medical directors involved in coverage denials.
The scope matters. Those business acquisition records — linking the naviHealth purchase to cost-cutting goals — could prove especially significant if they show the tool was built to save money rather than support care decisions.
A Case That’s Been Building Since 2023
The original lawsuit was filed in November 2023 by families of two deceased Medicare Advantage members who alleged they were denied necessary post-acute care. In February 2025, a federal judge dismissed several counts but allowed breach of contract claims to proceed, ruling that UnitedHealth’s appeals process was effectively “futile” — a finding that waived the usual requirement to exhaust administrative remedies first.
The case has broad implications for the nursing home industry. For facilities already navigating ongoing Medicare reimbursement battles, a ruling that forces transparency into how insurers use AI to cut short post-acute stays could reshape how payers and providers negotiate over length-of-care decisions.
UnitedHealth has 21 days to produce the required documents.
