What nH Predict is, who it affects, and what is happening in federal court right now. If your Medicare Advantage plan is through UnitedHealthcare or Humana, this guide is for you.
nH Predict is an AI-based tool developed by NaviHealth, acquired by UnitedHealth Group through its Optum division in 2020. The tool analyzes patient data — diagnoses, age, and functional ability — and produces a prediction of how long a patient will need post-acute care such as a skilled nursing facility stay, inpatient rehabilitation, or home health services.
According to a 2023 investigation by STAT News and subsequent federal lawsuits, UnitedHealthcare set an internal performance target: case managers were expected to keep patient rehabilitation stays within 1% of whatever nH Predict projected. Employees who deviated from the algorithm's recommendations faced disciplinary action, including termination.
The lawsuits allege that nH Predict has a 90% error rate. That number comes from looking at how often the algorithm's denial recommendations were reversed when patients or providers appealed. Nine out of ten appealed denials were overturned.
Two class action lawsuits are currently active, both filed in 2023. The UnitedHealth case — Estate of Gene B. Lokken v. UnitedHealth Group — had key claims allowed to move forward in February 2025, including breach of contract and breach of the implied covenant of good faith and fair dealing. The court noted that UnitedHealthcare's own plan documents promised coverage decisions would be made by clinical staff and physicians. The court ordered UnitedHealth to produce internal documents dating back to 2017. The Humana case is proceeding separately with similar claims.
nH Predict specifically affects Medicare Advantage patients receiving post-acute care:
