Legal
February 12, 2025

A federal court let the AI claim-denial case against UnitedHealth move forward

A federal court let breach claims proceed over UnitedHealth's nH Predict AI denials, signaling that 'the algorithm decided' is no liability shield.

Lady Justice with scales, representing the AI claim-denial court ruling

A federal judge in Minnesota allowed breach-of-contract and breach-of-good-faith claims to proceed in the suit alleging UnitedHealth's nH Predict tool drove wrongful Medicare Advantage denials of post-acute care. Many state-law claims were dismissed as preempted, but the contract claims survived. The takeaway for any organization deploying AI in coverage or clinical decisions: an algorithm decided it is not shaping up to be a legal shield. Where a model influences a decision that affects a patient, accountability still lands on the entity that used it. This is an early test case, and how it resolves will shape how AI-assisted decisions get documented and defended.

Source
DLA Piper
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