AI Denied Their Care, Now UnitedHealth Faces A Major Lawsuit

A federal judge has ruled that a major lawsuit against UnitedHealth Group (UHG) can continue, despite dropping some of the claims.

The lawsuit accuses UHG and its partners, UnitedHealthcare and naviHealth, of using AI instead of doctors to decide whether elderly patients on Medicare Advantage plans should receive care, as first reported by Courthouse News Case (CNC).

The plaintiffs allege that UHG’s AI program, developed by its subsidiary naviHealth, has a 90% error rate. The automated decisions, according to the lawsuit, led to worsened health conditions for patients and, in some cases, even death.

The suit claims that despite the high error rate, the company continues to deny claims using the flawed system because only a small fraction of policyholders—around 0.2%—appeal these denials, with the rest either paying out of pocket or going without care.

UHG is the largest health insurance company in the U.S., covering nearly 53 million people. The company has already faced heavy criticism over claim denials, especially after the shocking murder of former UnitedHealthcare CEO Brian Thompson in New York last year, as reported in an earlier article by CNC.

Police found bullet casings at the scene with the words “deny,” “defend,” and “depose” written on them—terms allegedly tied to UHG’s claims practices. The suspect, Luigi Mangione, has pleaded not guilty and raised $300,000 in donations for his defense.

UHG tried to get the lawsuit dismissed, arguing that the patients didn’t fully go through the company’s appeals process. But Judge John Tunheim disagreed, saying UHG’s appeal system was so difficult that it was nearly impossible for patients to get a fair review.

He said the process was “futile” and could cause “irreparable harm,” as reported by CNC.

One example highlighted in the complaint involves a 74-year-old stroke patient who was denied post-acute care despite his doctor’s recommendation. The man was forced to pay over $70,000 in medical expenses out of pocket before he passed away in an assisted living facility.

Now, the lawsuit will focus on whether UHG broke its own contracts by refusing to pay for care it had promised. Lawyers for both sides have not yet commented on the case.